"These codes represent at least 30 minutes of time spent beyond the usual E&M visit, and require documentation of both time and the medical necessity for spending the additional time. Unusual clinical situations may warrant prolonged face-to-face contact between physician and patient, and when that time exceeds 30 minutes, the provider may submit for payment in addition to the base Evaluation & Management (E&M) code. Additional time spent does not have to be continuous, and can represent the sum of incremental periods in a given day."
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