The add-on codes for prolonged services, 99354 and 99355 are now applicable to face-to-face outpatient mental health as well as for E/M codes. Previously these codes were only reimbursable if used with E/M codes.
+99354 – Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service, first hour
+99355 – Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service, each additional 30 minutes
Previously CPT code 90837 was the longest code to report individual psychotherapy. The 90837 indicates 60 minutes. If a doctor or therapist saw a patient longer than one hour there was no way to report the additional time. With this new rule, add-on codes can be used to report the additional time.
For example, if a psychologist spends 90 minutes with a patient face to face for individual psychotherapy they would report the 90837 and the 99354. If they spent two hours and thirty minutes, it would be reported using the 90837, 99354, and one unit of 99355.
It is important that the patients chart is noted with the time spent with the patient. Even though these add-on codes can be applied to outpatient mental health it doesn’t mean that all insurances or all plans will cover the add-on codes. Also, prior authorization rules would still apply as well.
They have also created two new add-on prolonged service codes. +99415 and +99416 are to report prolonged face to face services performed by a physician, NP or PA. These prolonged service codes start at services > 45 minutes.
Note: The + in front of a CPT code indicates that it is an add-on code and that a primary CPT code must be used.