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99358 Again

Today I find an article on AAPC regarding Medicare will pay for 99358.

https://www.aapc.com/blog/37804-cms-covers-99358-99359-prolonged-service/

CMS Now Covers 99358, +99359 Prolonged Services

Worker’s Comp also covers it.
1. Prolonged Service codes – non-face-to-face time – CPT codes 99358 and 99359 have been restored as billable codes. Their Billing Status in the fee schedule has changed to “A” – a billable code. Many orthopaedic practices used these codes to bill non face-to-face time for review of records. Medicare realized that the value of this additional work was not included in the value of the E&M services and they restored providers’ ability to bill these codes and in the update, DWC is following suit. It is important to remember the CPT definition of these codes:
99358 – Prolonged evaluation and management service before and/or after direct patient care, first hour.
99359 – each additional 30 minutes
It is not required that the time be continuous or spent all on the same day, however, prolonged service of less than 30 minutes total duration on a given date is not separately reported. Previously DWC had allowed the billing of these codes in 15 minute increments. Physicians will need to document the time spent in their reports. It is unclear whether DWC will also allow physicians to bill for the report. COA has asked DWC to clarify this point.

Per above 2 documents, Medicare and WC will both cover it except other commercial carriers.

Blackhorse, CPC-A

Medical Billing and Coding Forum