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    OpenPayerBilling CodesProlonged Service on Date Other Than the Face-to-Face Evaluation and Management Service Without Direct Patient ContactCPT cpt-99358-prolonged-non-face-to-face-evaluation
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    CPT 99358: Prolonged Pre- or Post-Encounter Evaluation

    Commercial payers pay $122 on average nationally for this procedure.

    CPT code 99358 describes a prolonged evaluation and management service provided by a clinician for time spent in preparation for or evaluation of the outcome of treatment that occurs before or after a direct patient encounter; the service type is prolonged E/M time without direct patient contact, and the typical site of service is an office or outpatient setting where administrative or clinical review and documentation occur.

    For related coverage guidance, see recent payer policy updates: Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure, Cardiology - Ivabradine, Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA).

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    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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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99359Prolonged evaluation and management service before and/or after direct patient care; each additional 30 minutesUsed to report additional blocks of prolonged non-face-to-face time beyond the first unit captured by 99358

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207R00000X
    208D00000X
    207Q00000X
    224P00000X
    103GC0700X
    246QH0600X
    207T00000X
    224ZR0403X

    Related Payer Policy Updates

    Specialty: Cardiology1 / 4

    10 rows

    PolicyPayerEffective Date
    Automated Ambulatory Blood Pressure Monitoring for Diagnosis of Hypertension in Patients with Elevated Office Blood PressureBluecross Idaho2026-11-01
    Cardiology - IvabradineCigna2026-10-15
    Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA)univerahealthcare2026-10-15
    Percutaneous Ventricular Assist DeviceUnitedHealthcare2026-10-01
    Cardiovascular Disease Risk AssessmentOscar Health2026-10-01
    Biomarkers for Myocardial Infarction and Chronic Heart FailureOscar Health2026-10-01
    Multiple Procedure Payment Reduction for Diagnostic Cardiovascular ProceduresBlue Cross Blue Shield - Maine2026-10-01
    Left Atrial Appendage Closure Devicesexcellus_health_plan_inc2026-09-17
    Left Atrial Appendage Closure Devicesuniverahealthcare2026-09-17
    Cardiac Omnibus CodesCigna2026-09-15

    Related Codes

    CPT-99359-PROLONGED-NON-FACE-TO-FACE-EVALUATION-30-MIN

    CPT 99359: Prolonged Non‑Face‑to‑Face Evaluation/Management

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    99417Prolonged time without direct patient contact on the date of office or other outpatient servicesAlternate code for reporting prolonged non-face-to-face time linked to outpatient E/M services on the same date