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CPT 99358: Prolonged Pre- or Post-Encounter Evaluation

CPT code 99358 designates prolonged evaluation and management time performed outside direct patient contact, specifically for preparation before or evaluation after a patient encounter. Nationally, this code captures non-face-to-face clinician work that supplements office and outpatient evaluation and management services and can affect documentation, billing workflows, and resource accounting across practices.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for using CPT code 99358, guidance on typical sites of service, and a comparison to adjacent prolonged-service codes to clarify when this code applies. The publication outlines benchmarking and reimbursement considerations for major payers, highlights common documentation expectations, and summarizes related coding pathways for prolonged services.

This summary provides clinicians, coders, and policy stakeholders with the operational context needed to identify appropriate circumstances for reporting CPT code 99358, understand payer coverage scope, and navigate related prolonged service codes in outpatient care settings.

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Billing Code Overview

CPT code 99358 reports time spent by a provider in preparation for or evaluation of the outcome of treatment that occurs before or after a direct patient encounter. This service represents work performed outside face-to-face patient contact focused on planning, reviewing records, or assessing treatment results.

Service type: Prolonged non-face-to-face evaluation and management time surrounding a patient encounter
Typical site of service: Office or other outpatient setting where the provider conducts preparatory or follow-up work related to patient care

National Reimbursement Benchmarks

National commercial rates for CPT 99358 cluster around BUCA’s average commercial value of $122.20, with notable variation among individual payers. UnitedHealth Group posts the highest central tendency with a median of $149.60 and a mean of $162.30, while Cigna shows a median of $134.00 and a mean of $147.80. Blue Cross Blue Shield’s median sits at $105.30 with a mean of $113.80, and Aetna’s median is $83.00 with a mean of $81.80. BUCA’s median of $113.70 and mean of $122.20 suggest the overall market centers in the low-to-mid $100s for this service.

Dispersion measured as the interquartile range (P75–P25) highlights where rates are tightest and widest: Aetna has the tightest IQR at $56.30 (P75 $100.00 minus P25 $43.70), while UnitedHealth Group shows the widest IQR at $91.90 (P75 $202.30 minus P25 $110.40). Cigna’s IQR is $97.00, Blue Cross Blue Shield’s is $44.10, and BUCA’s is $60.90, indicating meaningful variability in contracted commercial pricing across payers despite a clustered national average.

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CPT 99358: Prolonged Pre- or Post-Encounter Evaluation

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Billing Code Overview

Service type: Prolonged non-face-to-face evaluation and management time surrounding a patient encounter
Typical site of service: Office or other outpatient setting where the provider conducts preparatory or follow-up work related to patient care

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents for follow-up after initiation of a new chronic disease management plan. The clinician performs a brief face-to-face office visit to address urgent questions and medication adjustments, then spends an additional 40 minutes outside of the direct encounter reviewing laboratory results, imaging, and multi-specialty consultation notes, synthesizing findings, and preparing a detailed plan and documentation of outcomes. The visit includes counseling components and administrative review (for example, completion of forms and coordination of care). The provider documents the total non-face-to-face time spent preparing for and evaluating the outcome of treatment to support reporting of 99358 for prolonged evaluation and management services before and/or after direct patient care. Typical workflow steps include retrieval and review of electronic records, focused literature review for complex management decisions, telephone outreach to specialists or the patient, and preparation of a written summary added to the medical record.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service	When an unrelated E/M encounter occurs on the same day as another service and needs distinct reporting alongside `99358` follow-up work
`26`	Professional component	When billing only the provider's professional work related to the prolonged E/M activity
`22`	Increased procedural services	When the non-face-to-face preparation/evaluation involves substantially greater work than typical and documentation supports increased complexity
`52`	Reduced services	When the non-face-to-face time or services were partially performed and reduced from typical expectations
`53`	Discontinued procedure	When preparation was initiated but the follow-up evaluation was discontinued and documentation supports reporting
`59`	Distinct procedural service (note: not listed in raw modifiers; not allowed)	Data not available in the input.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When the preparatory or outcome evaluation includes real-time telemedicine sessions that are part of the prolonged E/M work
`78`	Return to the operating room for a related procedure during the postoperative period	When relevant to surgical patients needing post-op prolonged evaluation (used sparingly and only if applicable)
`80`	Assistant at surgery	When an assistant at surgery also documents prolonged pre/post operative evaluation time (rare)
`62`	Two surgeons	When two surgeons share prolonged pre/post op evaluation responsibilities
`26`	Professional component	When billing only the provider's professional work related to the prolonged E/M activity

Taxonomy Code	Specialty	Notes
`207R00000X`	Internal Medicine Physician	Common providers delivering complex non-face-to-face evaluation and management services
`208D00000X`	General Practice Physician	Provides generalist evaluation and prolonged documentation/coordination work
`207Q00000X`	Family Medicine Physician	Frequently performs longitudinal care requiring extended pre/post encounter evaluation

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z71.9`	Counseling, unspecified	Counseling may be part of the pre- or post-encounter work the clinician documents when preparing or evaluating treatment outcomes
`Z76.89`	Persons encountering health services in other specified circumstances	Administrative or non-routine encounters that require additional preparatory or evaluative time supporting `99358`
`R69`	Illness, unspecified	When a definitive diagnosis is pending, extended review and coordination time may be needed to assess outcome and next steps
`Z02.89`	Encounter for other administrative examinations	Administrative examinations or paperwork that require provider preparation or post-encounter follow-up work
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Preventive or routine examinations where additional preparatory evaluation or outcome review is documented

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99359`	Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes	Used to report additional blocks of prolonged non-face-to-face time beyond the first unit captured by `99358`
`99417`	Prolonged time without direct patient contact on the date of office or other outpatient services	Alternate code for reporting prolonged non-face-to-face time linked to outpatient E/M services on the same date

CPT 99359: Prolonged Non–Face-to-Face Service, Each Additional 30 Minutes

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service	When an unrelated E/M encounter occurs on the same day as another service and needs distinct reporting alongside `99358` follow-up work
`26`	Professional component	When billing only the provider's professional work related to the prolonged E/M activity
`22`	Increased procedural services	When the non-face-to-face preparation/evaluation involves substantially greater work than typical and documentation supports increased complexity
`52`	Reduced services	When the non-face-to-face time or services were partially performed and reduced from typical expectations
`53`	Discontinued procedure	When preparation was initiated but the follow-up evaluation was discontinued and documentation supports reporting
`59`	Distinct procedural service (note: not listed in raw modifiers; not allowed)	Data not available in the input.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	When the preparatory or outcome evaluation includes real-time telemedicine sessions that are part of the prolonged E/M work
`78`	Return to the operating room for a related procedure during the postoperative period	When relevant to surgical patients needing post-op prolonged evaluation (used sparingly and only if applicable)
`80`	Assistant at surgery	When an assistant at surgery also documents prolonged pre/post operative evaluation time (rare)
`62`	Two surgeons	When two surgeons share prolonged pre/post op evaluation responsibilities
`26`	Professional component	When billing only the provider's professional work related to the prolonged E/M activity

Taxonomy Code	Specialty	Notes
`207R00000X`	Internal Medicine Physician	Common providers delivering complex non-face-to-face evaluation and management services
`208D00000X`	General Practice Physician	Provides generalist evaluation and prolonged documentation/coordination work
`207Q00000X`	Family Medicine Physician	Frequently performs longitudinal care requiring extended pre/post encounter evaluation

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z71.9`	Counseling, unspecified	Counseling may be part of the pre- or post-encounter work the clinician documents when preparing or evaluating treatment outcomes
`Z76.89`	Persons encountering health services in other specified circumstances	Administrative or non-routine encounters that require additional preparatory or evaluative time supporting `99358`
`R69`	Illness, unspecified	When a definitive diagnosis is pending, extended review and coordination time may be needed to assess outcome and next steps
`Z02.89`	Encounter for other administrative examinations	Administrative examinations or paperwork that require provider preparation or post-encounter follow-up work
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Preventive or routine examinations where additional preparatory evaluation or outcome review is documented

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99359`	Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutes	Used to report additional blocks of prolonged non-face-to-face time beyond the first unit captured by `99358`
`99417`	Prolonged time without direct patient contact on the date of office or other outpatient services	Alternate code for reporting prolonged non-face-to-face time linked to outpatient E/M services on the same date

CPT 99359: Prolonged Non–Face-to-Face Service, Each Additional 30 Minutes

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

CPT 99358: Prolonged Pre- or Post-Encounter Evaluation

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Billing Code Overview

National Reimbursement Benchmarks

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Catch payer policy changes before they impact reimbursement

OpenPayer

CPT 99358: Prolonged Pre- or Post-Encounter Evaluation

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Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References