Wiki G2212/99417

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lgirouard14

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Does anyone have any concrete information regarding these additional codes we can use for prolonged E/M Services. The information below is what was sent to us from our Medicaid program. So for an established patient can we not bill for a prolonged service unless it is 69 min or longer? What about the extra 15 min from 54-69 minutes? And the same goes for a new patient? Any and all information would be very helpful! Thank you!
Billing Guidance for Code G2212 with CPT Code 99205
CPT Codes 99205
Codes on claims
60-74 Minutes99205
89-103 Minutes99205 and G2212(1 unit)
104-118 Minutes99205 and G2212 (2 units)
119 Minutes or More99205 and G2212 (3 units or more for each additional 15 minutes)

Billing Guidance for Code G2212 with CPT Code 99215
CPT Code 99215
Codes on claims
40-54 Minutes99215
69-83 Minutes99215 and G2212 (1 unit)
84-98 Minutes99215 and G2212 (2units)
99 Minutes or More99215 and G2212(3 units or more for each additional 15 minutes)
 
Medicare and the AMA do not agree on how to define the time factors of "prolonged service". For both, howevever, you can only count time that requires practitioner knowledge and expertise. For instance, time spent waiting on hold, leaving a message, etc., are not counted. Time spent speaking to a licensed professional on the phone for peer-to-peer review would count.

Medicare has determined that the entire 15 minutes must elapse before you can use the code. So for 99215, the upper limit is 54 minutes. A full 15 minutes have not elapsed until 69 minutes. Hence the difference between G2212 and 99417.

Some payers will follow Medicare. Blue Shield of California has decided to follow Medicare (of course; it is financially to their advantage).
 
Ok, so I found this on another website...this seems to follow what you are saying, so this would be correct?
CodesTime rangeCPT: times to add on 99417CMS: times to add on G2212
9920560-74 min.75-89 min.89-103 min.
9921540-54 min.55-69 min.69-83 min.
 
pedihc said:
Ok, so I found this on another website...this seems to follow what you are saying, so this would be correct?
CodesTime rangeCPT: times to add on 99417CMS: times to add on G2212
9920560-74 min.75-89 min.89-103 min.
9921540-54 min.55-69 min.69-83 min.
Click to expand...
Yes. If you'll search my posts, you'll find a chart I made that I posted.
 
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