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Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). If you experience any issues or have forgotten your Username, contact apa@psych.org or call APA . endstream endobj 206 0 obj <> endobj 207 0 obj <>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/Type/Page>> endobj 208 0 obj <>stream It might also be used for procedures that require some degree of explanation or justification. 99213 versus 99214: Are You Coding Correctly or - Pat Bass Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. Correct but then you kinda have to make that decision partway through the encounter. It offers higher revenue/reimbursement than some similar CPT codes, including CPT Code 99213. Cardiovascular - Negative for chest pain, orthopnea or PND "*e+aUw=CMIR0GK!ySS$o0mb/yRT1\FU.Mr"/&DE4Wlgp)pLa${yWS#aUG:Ub:TU!tL{yUFdt^TcI}%p6B \ l1N(cLS/35{{s!-BAyiKePio35rJ4@[iF3]c This has especially been the case since changes were made back in 2013, along with the Affordable Care Acts inclusion of mental healthcare in 2006. The Evolution of Therapy: 3 Big Changes That Are Implementing Better Mental BCBS to Reimburse LICSWs for Screening and Assessments, 7 Things a Person With a Mental Illness Doesnt Want to Hear, Medical decision-making with low complexity, Medical decision-making that can be considered to be of moderate complexity. Technically, the way it is written you can do it in actual practice you will not get away with that. Tell them they have to reschedule? Assessment/Plan: Depression with anxiety F41.8 well controlled. https://i0.wp.com/mentegram.com/wp-content/uploads/2017/04/Cpt-99213-and-99214.jpg?fit=960%2C540&ssl=1, //mentegram.com/wp-content/uploads/2014/09/mentegram_logo-website_main.png, CPT Codes 99213 and 99214: Behavioral Assessment Billing. Am I going to be able to do some basic therapy and bill this as a 99213 + add on code or bill it as a 99214 based on time? However, it can also be even more easily collected through assessments that are filled out in the waiting room. Patients with 2 problems: Document the problems, at least 4 symptom elements in the HPI (such as severity, duration, timing, and quality), at least 9 items on the mental status exam, 2 ROS categories (not necessarily psychiatric), and social history (such as spending more time with friends). JavaScript is disabled. No cervical adenopathy. Mental healthcare providers may also use these tools to help. You want to get paid quickly, in full, and not have to do more than spend 10 or 15 minutes to input your weekly calendar. When the psychiatrist also administers the anesthesia for ECT, the anesthesia service should be reported separately, using an anesthesia code. Requires all THREE Key Components (Hx,Exam,and Decision Making) Jump to first page 26 Established Patients -Think : 99212 -One stable condition 99213 -Two stable problems, OTC tx. (2;4222;;;;;;;;;;;;;;;;;@@@@@;@@@@@@@@@@@@@@@@@@@@@ x " Bilateral ankle exam: L ant drawer is negative, inversion testing on L causes pain, focal mild tenderness and swelling just below L lat malleolus. ABDOMEN: soft, nontender, moderate L CVA tenderness. Although this would seem to be a very useful code, because reviewing data is not a face-to-face service with the patient, Medicare will not reimburse for this code and some commercial carriers have followed suit. Also, what do you do with people who are, say, six minutes late to their appointment? CPT Code 99213 is a level three code that should be used for an established patient. Medicare will not reimburse for either of these codes. This visit only meets one out of three criteria, so it can't be coded as a level 4 based on MDM. I've been told most folks are billing 99214 + 90833 for 30-min follow-ups to maximize RVUs - is this legit? Most all visits involve at least 2 diagnoses. "A psychiatric patient with a sufficient degree of support in the outpatient setting or the decision to not hospitalize a patient with advanced dementia with an acute condition that would generally warrant inpatient care, but for whom the goal is palliative treatment." Risks associated with social determinants of health are also addressed: CMS has finalized the following services to be added to the Category 1 list: Group psychotherapy (CPT code 90853) Psychological and neuropsychological testing (CPT code 96121) . CPT Code 99214 Description (2023) | Medical Billing RCM Outpatient Mental Health CPT Codes: 90832 - Psychotherapy, 30 minutes ( 16-37 minutes ). The good news is that it is not only for mental health providers or therapists. JFIF Adobe d # $&& $ %4/ $('++9+'()02520)7;;;;7;;;;;;;;;;;;;;; $2(! Codes 90832-90834 represent insight oriented, behavior modifying, supportive, An important difference between coding based on MDM versus total time is that you may count MDM that occurs outside of the date of service (e.g., data reviewed or ordered the day after the patient's visit). TheraThink.com 2023. ^ugwj`b+AO_D>uSl^O?X-g|m- ?P{@; Loh @8-cIe[W` M`EMDu/zvHZ>}O & Thank you. Another way to simplify coding level 4 visits is to recognize that ordering labs, x-rays, ECGs, and medications (prescription drug management) often signals level 4 work, while using independent historians, discussing care/studies with external physicians, and providing care limited by social determinants of health are not used as often to code level 4 visits. Personal belief: If you spent the time, effort and money to go through psychiatry residency +/- fellowship, you should be able to decide if you're doing "16+ minutes of psychotherapy" - not the insurance company. Online clinics delivered at-home ketamine throughout the pandemic, and were just becoming aware of the consequences. Explanation: Total time for this visit was 20 minutes (but not documented in note). I document the time (and obviously the things needed for E&M), and since psychotherapy notes are privileged, I don't think the insurance has had a problem with it (no audits). TheraThink provides an affordable and incredibly easy solution. This has especially been the case since changes were made back in 2013, along with the Affordable Care Acts inclusion of mental healthcare in 2006. Preparation of Report of Patients Psychiatric Status, History, Treatment, or Progress (Other Than for Legal or Consultative Purposes) for Other Physicians, Agencies, or Insurance Carriers. Make sure code 99214 is only used with established clients you have already seen. 637 0 obj <> endobj Individual Psychophysiological Therapy Incorporating Biofeedback. Psych Practice E amp M Coding in All Its Glory. We established a mental health billing service at TheraThink to help you stay away from all this jargon so you can focus on what you do best. CPT Code 99214 is a level four code that can be used only for an established patient, whether the visit is conducted in the office or in an outpatient atmosphere. At that point you are an -entire- patient behind. that must be present to bill for each code. Strep screen neg. *kT1Rq:/(Rr9[>YsvYNz"gRRIk2:Os]o.YS!k|:tj_;p]qM5*BjF-]&Mj{Kc8emt/6MrL5R.85'VYM+/g-nV-%cWu:S6{Q:[{_Ws'4.3I{Ti_|]W4.sYy{{y#Nh]W3'4.k&y$E: : 4iy8Xm}#m&{o\>+3\]Gcjrh{hW$xs=v1n.n5ee)4X6vI$}[Vh5gBkkCRk(^{]n5Fv;s8}IJqiU%%u}Ei0;ryu8g]~5 sRuit|)| uJ{(w3:+K.D(oP li9M-~~iiKT2392J_cEC&j_mp>M>[D4FOnVQ2r=Sbk+K0y.Rq)6j7!975ii6'4Im-kYU,*&W-y(R0tV0xS10Z"63-.4Dl&|$H`h(K"884d%;DMsj{rp{%(9Rt"Jx+vfQ[EY2%pht38VUF%u0Yva>Z2GLNYkc9&gzws6E,Yvi-jWfZF[ E5M'HY^>C&E"JU! Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. HEART: S1 and S2 w/o murmurs. By documenting the recent housing insecurity and how that could affect the patient's ability to manage their diabetes, a 99214 code ($131.20) vs. a 99213 code ($92.47) can be billed. Current Procedural Terminology, Cpt 2003 - American Medical Association 2003-03-01 Psychotherapy for the Advanced Practice Psychiatric Nurse, Second Edition - Kathleen Wheeler, PhD, One acute complicated injury (e.g., concussion). Cipro 500 mg po bid x 7 days with appropriate precautions. This is due, in part, to more easily achieved factors for reimbursement on this code than with other CPT Codes, including 99214. examples of E/M codes across specialties An attempt was made to revise the office and other outpatient examples Not enough specialties participated CPT decided to hold off on example revisions for the new code definitions For now, examples related to these code have been deleted Nonetheless, AACAP and APA collaborated on The level of MDM should be driven by the nature of the presenting problem on the date of the encounter. These are the basic parameters for coding a level 4 visit based on total time or MDM under the new rules. Two out of three criteria meet the requirements for a level 4, so code it as a level 4. nEH^iJANQ(iXTBHEu6EUwQ{ Rule changes that eliminated the history and exam portions from coding requirements should make it easier to identify level 4 office visits and code them for appropriate reimbursement. Was level 4 risk managed? Some insurance companies only pay 15% over the Medicaid rate in their state, whereas others pay 45%, 60%, 80%, 85% on top of their states medicaid rate. CV: RRR These terms or unique code tends to be uniform all around The United States, which helps in effective billing. HnHj/` vv. (2;4222;;;;;;;;;;;;;;;;;@@@@@;@@@@@@@@@@@@@@@@@@@@@ $2(! PDF Outpatient Psychiatry & Psychology Services Fact Sheet CPT code 99214 is used for established patient E/M services. The national average for family physicians' usage of the level 4 code (99214) is slowly increasing and is approaching 50% of established patient office visits (it's now above 50% for our Medicare patients).2. Mental healthcare providers may also use these tools to help reduce and even replace paperwork. RTC 2 mo to recheck depression. Extended exam of the affected body region or organ system: For the purposes of examination these body areas are recognized - Head, including the face; Neck; Chest, including breasts and axillae; Abdomen; Genitalia, groin, buttocks; Back, including spine; and Each extremity Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time. 3. You must have JavaScript enabled to enjoy a limited number of articles over the next 30 days. This can save valuable time in patient intake and with screening the patients and monitoring their progression, even in between appointments. CLINICAL EXAMPLE 99213 - E/M University Reimbursement seems similar to 2x99214 actually. Clinical example 99214 E/M coding, EM evaluation and management coding I've been in practice since 2019. 99214: Patients with 2 problems: Document the problems, at least 4 symptom "elements" in the HPI (such as severity, duration, timing, and quality), at least 9 items on the mental status exam, 2 ROS categories (not necessarily psychiatric), and social history (such as "spending more time with friends"). The total time needed for a level 4 visit with an established patient (CPT code 99214) is 30-39 minutes. Group 1 Paragraph. The activities covered by this code include physician visits to a work site to improve work conditions for a particular patient, visits to community-based organizations on behalf of a chronically mentally ill patient to discuss a change in living conditions, or accompaniment of a patient with a phobia in order to help desensitize the patient to a stimulus. CPT Code 99214 - Moderate Complexity E/m Billing Guide [+2023 The bar is low. He denies chest pain, fast heart rate, headache, flushing, or nose-bleeds. Trouble is if even one of these folks shows up and against expectations everything is -not- copacetic this time, you might end up taking 30-40 minutes dealing with the situation. If I am meaningfully addressing two chronic and stable disorders that the patient legitimately can be diagnosed with, and I am making decisions about pharmacotherapy/monitoring adverse effects/discussing alternatives, I do not see how you cannot meet the MDM criteria for 99214 with the current guidelines as written. While not all insurance companies accept the code 99214, many do. A great example of a primary care doctor using CPT Code 99214 is when an existing patient comes in for a routine health examination for chronic pain. nmanojkumarame Did you prescribe a medication and either interpret an x-ray (or ECG) or order/review three tests? Therefore, it is no surprise that CPT Code 99214 is used the most frequently for this form of visit. This way, all clinicians billing with these codes can receive the highest reimbursement for their services. Here are three questions you can ask yourself to quickly determine whether you've just performed a level 4 visit: Was your total time between 30 and 39 minutes for an established patient, or between 45 and 59 minutes for a new patient? 99214: 25: 30-39: 99215: 40: 40-54: . This code is for electroconvulsive therapy (ECT), which involves the application of electric current to the patients brain for the purposes of producing a seizure or series of seizures to alleviate mental symptoms. Severe and profound intellectual disabilities (ICD-10-CM codes F72, F73, and F79) are never covered for psychotherapy services or psychoanalysis (CPT codes 90832-90840, 90845-90849 and 90853). Email Address . Many EHRs have time calculators that will show the amount of time you have had the patient's chart open. Assessment/Plan: Essential hypertension I10. Objective: T 100.2, P 96, R 18, BP 110/70. Was level 4 data reviewed/ordered? Thank you. However, the flow of conversation may quickly turn to feelings of depression that are now accompanying this pain. Note: We only work with licensed mental health providers. 2021 Medicare Physician Fee Schedule Update: What Providers Need - BDO ECT is used primarily for the treatment of depression that does not respond to medication. Assessment/Plan: Pyelonephritis N12. 45-74 minutes, evaluation and management services, 75-104 minutes, evaluation and management services, +90840 Add-on code for an additional 30 minutes (, 90833 Evaluation and Management with 30 Minutes Psychotherapy, 90836 Evaluation and Management with 45 Minutes Psychotherapy, 90838 Evaluation and Management with 60 Minutes Psychotherapy. If so, then code it as a level 4 using MDM. Also keep in mind that decision making does not always need to include detailed exams. Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server. CPT Code 99214 is a level four code that can be used only for an established patient, whether the visit is conducted in the office or in an outpatient atmosphere. See if you can identify why each is a level 4 before you get to the explanation. We are your billing staff here to help. You may want to include a short definition of total time so that patients who read their notes don't confuse it with face-to-face time and think, My doctor only spent 20 minutes with me, not the 40 minutes listed here. For example, your documentation could say, Total time: 40 minutes. Here is a list of the most common evaluation and management psychiatry CPT codes: Please check out our extensive guide to 2021 reimbursement rates for psychiatrists. hmk0`_%ttuPkMjH[wDNKdt:$aDg&a`aDfsk % pRZs40D2T&UYP* Copyright - Mentegram, Inc, Austin TX, (512) 593-5835. endstream endobj startxref When you refer to "counseling and motivational interviewing"- are you referring to discussions about lifestyle and compliance with meds? endstream endobj startxref Remember it is not just severity of condition alone that is going to get out to 99215, you need the lab/consulting other providers/. Vitals: 120/80, 65, 98.6 CPT Coding and Reimbursement - American Psychiatric Association No: One stable chronic illness, one acute uncomplicated illness, and one acute uncomplicated injury. Now let's look at three examples of level 4 office visits, documented with the usual SOAP (subjective, objective, assessment, and plan) note. For patients who are chronically stable, just want refills in 10 minutes, and don't want supportive therapy, it seems like a waste of time to reserve them a full 20 or 30 minute slot. Psychiatry CPT Codes: The Definitive Guide [+Cheat Sheet PDF] Two problems, one of which is worsening: 99214. Level 4 office-visit coding - Contemporary Pediatrics CC : Follow-up hypertension and diabetes There are no new diagnosis or medications prescribed. Evaluation and Management (E/M) Patient Examples 99214 Office visit for a 13-year-old male, established patient, with depression, anxiety, and anger outbursts. It cannot be used with a new patient who has no history. General Coding. I cannot capture in words the value to me of TheraThink. M0064 should only be used for the briefest medication check with stable patients, Source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Practice-Management/Coding-Reimbursement-Medicare-Medicaid/Coding-Reimbursement/cpt-primer-for-psychiatrists.pdf, Other Source: https://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/business_of_practice/cpt/2018_CPT_module_revised_March_2018.pdf, e/m codesevaluation and management codesmental health billingpsych codespsych cpt codespsychiatry billingpsychiatry codespsychiatry cpt codespsychiatry reimbursement rates. Pt is NAD, affect is bright, eye contact is good. Medicare considers the review of data to be part of the pre-/postwork associated with any face-to-face service. The primary changes in the CPT codes include: developmental test administration neurobehavioral status exam psychological testing and evaluation neuropsychological testing and evaluation. This service is covered by some insurance plans, but because some of the activities are not face-to-face, the clinician should check with carriers about their willingness to reimburse for this code. Call or RTC sooner if problems or concerns develop. That is in the range of a level 3 visit, not a level 4. This patient may have had mild back pain for three or four years, being treated with muscle relaxants. Denny and his team are responsive, incredibly easy to work with, and know their stuff. Unlisted Psychiatric Service or Procedure. Standardized assessment tools for depression (e.g. PHARYNX: nl. This is due, in part, to more easily achieved factors for reimbursement on this code than with other CPT Codes, including 99214. Reimbursement for 99214 is more than 99212 or 99213. Will call if strep culture is positive. Generally, these billing codes are differentiated by amount of time spent with the patient and severity of the presenting problem. Assessment, For a detailed breakdown of this note with tips and advicesee99214 E/M Insight, An established office patient with hypertension, diabetes and a history of dyslipidemia, Repeat renal profile, spot microalbumin/creatinine at next visit, along with cbc, Check LFTs at next visit as well due to ongoing statin therapy, Continue lifestyle modifications and exercise for weight loss. I don't see a reason to use an E&M code for a visit that included no E&M. For example, if the total duration of face-to-face physician-patient time is 21 minutes, select code 99214 because the duration of visit is closer to 25 minutes, the average time for a 99214,. You free me to focus on the work I love!. Copyright 2021 by the American Academy of Family Physicians. PDF Science Health Science Psychiatry . Expert Explains Updated CPT Codes, How to Estimate E - Psychiatric News My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims. We will offer you a quick guide on most common psychiatry CPT Codes, explain evaluation and management (E/m) codes, and then provide an exhaustive list of all Psychiatry CPT codes. The 2021 Office Visit Coding Changes: Putting the Pieces Together, Coding Level 4 Office Visits Using the New E/M Guidelines, CPT E/M office revisions: level of medical decision making. Here are the rates that Medicare believes are the commercial insurance rates for these services (this is not the Medicare rate for 99214): These rates are adjusted down and reflect what Medicare has deemed are average rates for most psychiatrists across the United States. Yes: prescription drug management. While these two codes are within the same family, they do have different regulations for reimbursement. You free me to focus on the work I love!. Other CPT code severity requirements are listed below: Wondering if theres an easier way to navigate billing codes? Laboratory: UA TNTC, WBCs 4+ bacteria. Reaction score. But because the physician has documented that the visit met the criteria for a level 4 based on total time, it can be coded as a level 4. Medicare will not reimburse for this service because it is not done face-to-face with the patient, and clinicians should verify coverage by other insurers to ensure reimbursement. Did you see the patient for a level 4 problem and either prescribe a medication, interpret an x-ray (or ECG), or order/review three tests? I have some patients who are 99214 medically complex and I see them some months for weekly therapy. Revised Prolonged Services code 99417, new 99418, deleted codes 99354-99355, 99356- 99357. They are all part of HCPS, the Healthcare Common Procedure Coding System. 6RL\/\aUK\ hb```"fUaf`e`s4 General Surgery Sample Doctor 6,861 1,990 4,871 7,259 2,388 4,871 % Increase in Outpatient E/M wRVUs under 2021 Rule Internal Medicine 28% Allergy/Immunology 22% General Surgery 20% AMGA Production However, here's the breakdown for MDM: Was there a level 4 problem? This includes time spent with the patient during the visit as well as time spent before and after the visit reviewing the chart, documenting the encounter, making phone calls, reviewing studies, etc. In addition to preventing misunderstandings, this gives patients a better idea of all the time we spend on them outside of the actual visit. E/M Services Guide: Coding by Key Components (summary chart). depression or anxiety), requiring further testing or a new medication prescription. All Rights Reserved. 99214 psychiatry example Psychiatry PDF | PDFprof.com Clinical example 99214 E/M coding, EM evaluation and management coding, e&m documentation, 99214, 99213 Reviews (Avg: 4.9 / 5) of 80 This is Excellent and helps a lot to improve clinical documentation Deivanai March 24th, 2021 I GOT HELPFULL CONTENT FROM THIS SITE JAYESH January 14th, 2021 Best site and very good info. We do not Necessarily need anything in the middle column to meet the criteria for billing and coding. You aren't required to break down how much time you spent before, during, and after the visit, though that may be helpful supportive detail in the event of an audit. Any y'all still getting those letters from a certain 3rd party company the insurance companies have outsourced to for review billing numbers? I try to be extremely literal about this question. Therefore, it is no surprise that CPT Code 99214 is used the most frequently for this form of visit. How much more do the therapy add-on codes typically add to the encounter? T!A@0.#@40FP&WT. PDF Selecting a n E/M Code Based on Medical Decision Making in 2021 e !1AQ"Taq2BS34CDR CPT Codes 99213 and 99214: Behavioral Assessment Billing w-UQwk!fKcHZiquM!3FduW *-1UA-q3%uk.4[4{yM`WT:'!^`UU.G*H1y[U 99213 or 99214? Three Tips for Navigating the Coding Conundrum The problems are usually of a moderate to high complexity. This procedure is covered by most insurance plans. I think technically MDM (medical decision making) is not required to be 1 of the 2 currently, but that will change for Medicare starting January 2021. / This will help you keep track of time while you're reviewing the chart before the visit, performing the exam (if you always open the chart at the beginning of the visit and close it at the end of the encounter), and making notes after the visit. It may not display this or other websites correctly. Sertraline 50 mg refilled. Office of Corporate Compliance - University of Chicago Medicine Therapeutic Repetitive Transcranial Magnetic Stimulation (TMS) initial treatment, including cortical mapping, motor threshold determination, delivery and management, Subsequent TMS Delivery and Management, per session, Subsequent TMS Motor Threshold Re-Determination with Delivery and Management, Electroconvulsive Therapy (Includes Necessary Monitoring); Single seizure. Start: Dec 1, 2022 Get Offer. No hx of pyelo. This includes time spent with the patient, but also time spent before the visit reviewing the chart and time after the visit documenting the visit, etc. I have better things to do, like take care of my patients.. PDF JUST HOW MUCH DOCUMENTATION IS REQUIRED - HCCA Official Site CPT code 99214 describes a level 4 office or outpatient visit, typically a comprehensive evaluation and management of the patient's medical problems. Would it be economically more efficient to dedicate one day a week solely for 15 minute appointments to slot these quick patients? %PDF-1.5 % CPT Codes 99213 and 99214 may be billed in time-derived methods for each patient during each session where the guidelines for billing are met. Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, 2021 reimbursement rates for psychiatrists, insurance billing for your psychiatry practice, https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Practice-Management/Coding-Reimbursement-Medicare-Medicaid/Coding-Reimbursement/cpt-primer-for-psychiatrists.pdf, Inquire about our mental health insurance billing service, offload your mental health insurance billing, Psychiatric Diagnostic Evaluation without medical services, Psychiatric Diagnostic Evaluation with medical services, Therapeutic repetitive transcranial magnetic stimulation (TMS); initial, Therapeutic repetitive transcranial magnetic stimulation (TMS); subsequent, Therapeutic repetitive transcranial magnetic stimulation (TMS); subsequent motor threshold re-determination with delivery and management, Individual psychophysiological therapy incorporating biofeedback training, 30 minutes, Individual psychophysiological therapy incorporating biofeedback, 45 minutes, Unlisted psychiatric service or procedure, Biofeedback training, including EMG and/or manometry, E/M New Patient Office Visit 10 Minutes, E/M New Patient Office Visit 20 Minutes, E/M New Patient Office Visit 30 Minutes, E/M New Patient Office Visit 45 Minutes, E/M New Patient Office Visit 60 Minutes, Telephone therapy (psychiatrist), limit 3 units/hours per application, Psychotherapy, 30 minutes, with E/M service (90833), Psychotherapy, 45 minutes, with E/M service (90836), Psychotherapy, 60 minutes, with E/M service (90838), 96118 Neuropsychological testing by psychologist or physician, 96101 Psychological testing by psychologist or physician, Telephone E/M service provided to an established patient, parent/guardian, 5-10 minutes, Telephone E/M service provided to an established patient, parent/guardian, 11-20 minutes, Telephone E/M service provided to an established patient, parent/guardian, 21-30 minutes, 30 to 74 minutes, Prolonged Services With Direct Patient Contact Code Time beyond the time (90837) or typical time (E/M codes) of the primary service, 75 to 104 minutes, Prolonged Services With Direct Patient Contact Code Time beyond the time (90837) or typical time (E/M codes) of the primary service, additional 99355 each additional increment up to 30 minutes, 30 to 74 minutes, Prolonged Services Without Direct Patient Contact, additional increment up to 30 minutes, Prolonged Services Without Direct Patient Contact.