Threshold Times for Codes 99354 and 99355

 (Office or Other Outpatient Setting)

If the total direct face-to-face time equals or exceeds the threshold time for code 99354, but is less than the threshold time for code 99355, the physician should bill the evaluation and management visit code and code 99354. No more than one unit of 99354 is acceptable. If the total direct face-to-face time equals or exceeds the threshold time for code 99355 by no more than 29 minutes, the physician should bill the visit code 99354 and one unit of code 99355. One additional unit of code 99355 is billed for each additional increment of 30 minutes extended duration. Contractors use the following threshold times to determine if the prolonged services codes 99354 and/or 99355 can be billed with the office or other outpatient settings including domiciliary, rest home, or custodial care services and home services codes.



Threshold Time for Prolonged Visit Codes 99354 and/or 99355 Billed with Office/Outpatient 

Code     Typical Time for Code    Threshold Time to Bill Code 99354   Threshold Time to Bill Codes 99354 and 99355

99201  10  40  85
99202  20  50  95
99203  30  60  105
99204  45  75  120
99205  60  90  135
99212  10  40  85
99213  15  45  90
99214  25  55  100
99215  40  70  115
99324  20  50  95
99325  30  60  105
99326  45  75  120
99327  60  90  135
99328  75  105  150
99334  15  45  90
99335  25  55  100
99336  40  70  115
99337  60  90  135
99341  20  50  95
99342  30  60  105
99343  45  75  120
99344  60  90  135
99345  75  105  150
99347  15  45  90
99348  25  55  100
99349  40  70  115
99350  60  90  135


Add 30 minutes to the threshold time for billing codes 99354 and 99355 to get the threshold time for billing code 99354 and two units of code 99355. For example, to bill code 99354 and two units of code 99355 when billing a code 99205, the threshold time is 150 minutes.

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