Coding & Reimbursement

ASCO's Coding Tip of the Month: September 2023

In last month’s Tip of the Month, prolonged services for physicians and other qualified health care professionals on the date of service were discussed. However, there are other situations where prolonged services can be reported.  

  • When the prolonged services are provided by a physician/qualified healthcare professional on a date other than the date of the encounter:

    If prolonged services without direct patient contact occur on a date other than the face-to-face evaluation and manage service, codes 99358 and 99359 (prolonged evaluation and management before/after direct patient care for the first hour and each additional 30 minutes) can be used to report those prolonged services even if time wasn’t used to select the level of the E/M. It must relate to a face-to-face E/M that either will or has occurred and related to ongoing patient management. Note these codes are not actively paid by CMS.
  • When clinical staff time accounts for the prolonged services in office/outpatient setting:

    Clinical staff face-to-face time accounting for prolonged services should be reported with 99415 and 99416 (Prolonged clinical staff time during an evaluation and management service for first hour and each additional 30 minutes). This requires direct supervision AND direct patient contact on the date of the encounter by the physician or other qualified health care professional. The staff time does not have to be continuous but only the face-to-face time should be counted. Time counted towards services other than evaluation and management service cannot be used towards prolonged services.

Important Updates to Evaluation and Management Services in 2023

The American Medical Association has released the new guidelines for Evaluation and Management (E/M) services which will go into effect on January 1, 2023. The guidelines have been updated to bring all the services in line with the 2021 Evaluation and Management changes to office and outpatient E/M CPT codes. More information regarding CMS’ take on the 2023 E/M changes can be found in the 2023 MPFS (Medicare Physician Fee Schedule) Proposed Rule. See ASCO’s summary.

Check this page frequently for more updates and resources.

Coding and Reimbursement Updates


Evaluation & Management Services Changes

2021 Office and Outpatient Evaluation & Management Services Changes

Coding & Reimbursement Questions?

ASCO members can submit inquiries related to coding, reimbursement, or coverage via email. ASCO staff will respond to your question in a timely manner.