Additional Payment for Staff Time Begins in 2016

December 3rd, 2015

CPT has long recognized the need for codes to reimburse providers for the prolonged care of a patient. 

Until 2016 though, there was no apparent way to receive additional reimbursement because of the time a staff member spent in extended patient care.

With CPT 2016, two new codes are introduced to make reimbursement for this care possible.  They are:

99415: Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service) (Use 99415 in conjunction with 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215)  (Do not report 99415 in conjunction with 99354, 99355)


99416: each additional 30 minutes (List separately in addition to code for prolonged service) (Use 99416 in conjunction with 99415)

And YES, Medicare will pay for these codes (although not much).

Although payment will vary slightly by jurisdiction, Medicare will pay approximately $8.00 for the first hour and $.50 for each additional 30 minutes your staff is involved in caring for the patient beyond the evaluation and management service. 

You cannot charge this in addition to provider prolonged service codes.  Nor should you charge it if you can bill for another. more appropriate service during the time such as instructing the patient on using an inhaler.  Thus, in order to charge these codes:

  1. There must be an office based evaluation and management service,
  2. The staff must be involved in direct patient care beyond the provider provided evaluation and management service,
  3. The provider cannot also charge for prolonged services,
  4. The staff member must provide the service under the direction and supervision of the provider, and
  5. Another code does not better reflect the service provided.

So little you say?  Although the reimbursement is less than what you are likely paying the staff member per hours, something is better than nothing!

Tags: Staff Time, Prolonged Services


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