Prolonged Services: CPT® Guidelines and Medicare/Medicaid Policy

Abstract

This article addresses the following topics: Current Procedural Terminology (CPT) codes for prolonged evaluation and management (E/M) service codes are reported based on the occurrence or absence of a face-to-face visit on the same date in addition to time requirements. The Centers for Medicare & Medicaid Services (CMS) created Healthcare Common Procedure Coding System (HCPCS) codes with guidelines that vary significantly from the CPT guidelines. CMS does not always limit the time attributed to prolonged service to time on the date of the encounter.