99354

Prolonged Office or Outpatient E/M Service, First Hour (Deleted 2023)

The CPT code 99354 was historically utilized to report the first hour of prolonged physician or other qualified health care professional services with direct patient contact in the office or other outpatient setting. This service was intended to be reported in addition to the primary evaluation and management (E/M) service that has a specific time duration or a typical time assigned to it in its description. Specifically, 99354 was an add-on code used when the encounter exceeded the usual service time by at least 30 minutes. It covered the first 30 to 60 minutes of additional time spent face-to-face with the patient. As of the 2023 CPT code set update, 99354 was officially deleted by the American Medical Association (AMA) as part of an effort to streamline E/M reporting and align outpatient prolonged services with the newer 99417 code. During its period of use, clinicians were required to document the total time spent in the encounter and the specific clinical necessity for the extension, such as complex medical decision-making, extensive counseling for life-threatening diagnoses, or coordination of complex multidisciplinary care. The code could not be used for services lasting less than 30 minutes beyond the base time and required the clinician to be present with the patient. It was restricted to the outpatient or office setting and could not be billed independently of a qualifying base E/M code. Documentation needed to reflect the necessity of the prolonged duration to justify the additional reimbursement and time spent.

Clinical Indications

  • Management of patients with multiple chronic comorbidities requiring extensive history and exam
  • Extensive counseling for a patient newly diagnosed with a terminal or life-altering condition
  • Psychiatric crisis intervention when psychotherapy codes are not applicable
  • Lengthy coordination of care involving multiple specialists while the patient is present
  • Detailed review of outside medical records and test results in the presence of the patient

Procedure Steps

  1. Perform the standard components of a primary evaluation and management service.
  2. Identify the clinical need for time exceeding the typical duration of the primary E/M code.
  3. Engage in direct face-to-face contact with the patient or family for an additional 30 to 60 minutes.
  4. Provide counseling, coordination of care, or advanced medical decision-making.
  5. Record the start and end times of the total encounter or the specific prolonged segment.
  6. Document the specific medical necessity and content of the prolonged service.

Coding Guidelines

  • 99354 is an add-on code and must be reported in conjunction with a base E/M code (e.g., 99202-99205, 99212-99215).
  • Code 99354 was deleted effective January 1, 2023; practitioners should now use code 99417 for outpatient prolonged services.
  • A minimum of 30 minutes of additional face-to-face time beyond the base code was required to bill 99354.
  • Time spent in non-face-to-face activities was not reportable under this specific code.
  • Only one unit of 99354 could be reported per date of service; additional time was reported with 99355.

Associated ICD-10 Codes