Prolonged Services

Tags: cpt inpatient prolonged

Overview

Prolonged service codes are add-on codes for E/M services exceeding typical time.

Inpatient Prolonged Codes (2023+)

CPT	Description	Time
99417	Each 15 min beyond threshold	15 min increments

Threshold Requirements

Base Code	Typical Time	Prolonged Starts At
99221	40 min	55 min
99222	60 min	75 min
99223	80 min	95 min
99231	25 min	40 min
99232	40 min	55 min
99233	55 min	70 min

15-Minute Increments

Each unit of 99417 represents 15 minutes beyond the threshold.

Calculation Example

Service: 99233 (typical 55 min) Actual time: 100 minutes Threshold: 70 minutes Excess: 30 minutes Prolonged units: 2 (99417 x 2)

Documentation Requirements

Element	Requirement
Total Time	Document exact minutes
Activities	What was done during time
Medical Necessity	Why extended time needed

Critical Care Prolonged

Code	Description
99291	First 30-74 min critical care
99292	Each additional 30 min
99417	NOT used with critical care

Critical Care Exception

Do NOT use 99417 with critical care. Use 99292 for additional critical care time.

Payer Variability

Payer	99417 Accepted
Medicare	Yes (with G0316 alternative)
Commercial	Varies
Medicaid	Varies by state

Medicare G0316

Medicare has alternate prolonged service code G0316. Verify payer-specific requirements.

00 Inpatient ProFee Coding MOC M Codes Critical Care Codes