CPT 99359: Prolonged Non‑Face‑to‑Face Evaluation/Management
Commercial payers pay $55 on average nationally for this procedure.
CPT code 99359 describes a prolonged service consisting of additional non‑face‑to‑face time spent in preparation or in evaluating the outcome of treatment outside a direct patient encounter, billed for each additional 30 minutes beyond the initial hour; the service type is prolonged non‑face‑to‑face evaluation/management and the typical site of service is outpatient or office-based administrative/clinical time related to patient care.
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National Reimbursement Benchmarks
National commercial rates for CPT 99359 center around BUCA’s average of $55.10 as a reference for broad commercial pricing, while individual payers show meaningful variation. UnitedHealth Group posts the highest central tendency with a median of $69.00 and a mean of $76.40; Cigna’s mean is $68.50 with a median of $62.20; Blue Cross Blue Shield averages $50.60 with a median of $46.80; Aetna’s mean is lower at $33.60 with a median of $39.00. Maximums and minimums vary by payer but are omitted here for BUCA and Medicare per available conventions.
Dispersion measured by the interquartile span (P75 minus P25) highlights which payers are tighter or wider: Blue Cross Blue Shield’s IQR is $20.70, Aetna’s is $25.00, BUCA’s is $28.10, Cigna’s is $42.00, and UnitedHealth Group’s is $40.00. Cigna exhibits the widest middle-50% spread at $42.00, indicating greater variability in commercial rates, while Blue Cross Blue Shield is the tightest at $20.70.