Users' questions

What is the time requirement for 99214?

What is the time requirement for 99214?

If you spend at least 25 minutes with a patient and more than half the time involves counseling or coordination of care, you can code 99214 based on time.

How many minutes is 99245?


Outpatient – New
Codes 99201 99205
Outpatient – Consultation
Codes 99241 99245
Times 15 min. 80 min.

What is the CPT time rule?

Since the current psychotherapy codes are not for a range of time, like the old ones, but for a specific time, the CPT “time rule” applies. If the time is more than half the time of the code (i.e., for 90832 this would be 16 minutes) then that code can be used.

What is the threshold of time for reporting prolonged services?

Depending on the place of service, 99355 or 99357 is used to report each additional 30 minutes beyond the first hour. To report either of these codes, the prolonged service must extend at least 15 minutes beyond the first hour of prolonged service.

How often is the CPT code 99245 used?

To get an idea of the frequency of use of this code among sub-specialists, nephrologists used this level of care for 32% of consults performed in the office during that same year (which added up to 50,435 visits). The 99245 ranked 111th among the most frequently used CPT codes by all physicians in 2003.

When to report CPT code 99221 to CMS?

First, CMS reminds providers that CPT code 99221 may be reported for an E/M service if the requirements for billing that code, which are greater than CPT consultation codes 99251 and 99252, are met by the service furnished to the patient.

When to use the Office Consultation code 99241?

These codes are used to bill for office consultations with new or established patients. These codes are also used to bill for consults performed on patients in the ER or admitted under “observation” status. Internists performed a total of 1]

Do you have to meet a typical time for a 99214?

Remember, it is not necessary to meet the typical time of 25 minutes for a 99214 when the history, exam or medical decision making are the basis for the code selection.