Prolonged Other E/M Visits

30.6.15.3 Prolonged Other E/M Visits (Rev. 11842; Issued; 02-09-23 Effective:01-01-23; Implementation: 05-09-23) Beginning January 1, 2023, prolonged Other E/M visit services are reported as discussed in this section. Other E/M visits include inpatient/observation visits, nursing facility visits, home/residence visits, and cognitive impairment assessment and care planning. Prolonged Other E/M services may be reported with the highest visit level, for timed visits, when the total visit time spent by the practitioner exceeds a certain time threshold. Prolonged services are not reported in conjunction with emergency department visits or critical care services. Prolonged services are created to provide payment for additional practitioner time that is not already accounted for in the valuation of the primary service. Accordingly, practitioner time spent in qualifying activities can be counted when performed on any date within the surveyed timeframe for the visit, and when the total time (in the physician time file) is exceeded by 15 or more minutes. We show this in the following table. Primary E/M Service Prolonged Code* Time Threshold to Report Prolonged Count physician/NPP time spent within this time period (surveyed timeframe) Initial IP/Obs. Visit (99223) G0316 90 minutes Date of visit Subsequent IP/Obs. Visit (99233) G0316 65 minutes Date of visit IP/Obs. Same-Day Admission/Discharge (99236) G0316 110 minutes Date of visit to 3 days after IP/Obs. Discharge Day Management (99238-9) n/a n/a n/a Emergency Department Visits n/a n/a n/a Initial NF Visit (99306) G0317 95 minutes 1 day before visit + date of visit + 3 days after Subsequent NF Visit (99310) G0317 85 minutes 1 day before visit + date of visit + 3 days after NF Discharge Day Management n/a n/a n/a Home/Residence Visit New Pt (99345) G0318 140 minutes 3 days before visit + date of visit + 7 days after Home/Residence Visit Estab. Pt (99350) G0318 110 minutes 3 days before visit + date of visit + 7 days after Cognitive Assessment and Care Planning (99483) G2212 100 minutes 3 days before visit + date of visit + 7 days after Consults n/a n/a n/a * Time must be used to select visit level. Prolonged service time can be reported when furnished on any date within the primary visit’s surveyed timeframe and includes time with or without direct patient contact by the physician or NPP. Consistent with CPT’s approach, we do not assign a frequency limitation. Qualifying activities are listed in the CPT Codebook’s E/M Service Guidelines (Guidelines for Selecting Level of Service Based on Time). These activities may be counted when time is used to select visit level, when performed and medically reasonable and necessary.