Non-Face to Face Prolonged Care - Code 99358

We have a primary care physician who may not have the time to review
records at the time of the E/M visit. Records may be reviewed up to two to
three days later.

1) Will you be able to bill this code 99358 to Medicare separately or must
it always be billed in conjunction with an E/M visit on the same day?

And 2) if there is *NO E/M visit billed* (records were received prior to
being seen) can he still bill for it?

Last question, this is currently a bundled code per this
changing in 2017 for sure?

Thanks so much for your input!

Penny Sue
Century City Primary Care, LLC
(310) 553-4982 office
(310) 729-2758 cell

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  • edited May 2017
    Hi Penny,

    Thanks for the inquiry. To questions #1 and #2 below, here's what the 2017 proposed Medicare physician fee schedule says about the billing requirements related to prolonged service code 99358:

    "We propose to require the services to be furnished on the same day by the same physician or other billing practitioner as the companion E/M code."

    It appears CMS is going to require that a) 99358 be billed in conjunction with a "companion E/M" code on the same day. This is of concern to some coding experts, as you'll find in the July 25 article on the proposed prolonged services here:

    In response to your last question – yes, CMS is proposing to unbundle 99358 and 99359 in 2017. We'll know for sure when the final fee schedule appears later this year.

    Hope that helps.


    Richard Scott
    Part B News
    Medical Practice Coding Pro

  • Thanks Richard! Appreciate it!


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