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

CPT code 99359 covers prolonged clinician services performed outside a face-to-face visit, specifically each additional 30 minutes of preparation or outcome-evaluation time after the first hour. Nationally, this code captures time-intensive, non–direct patient care activities that contribute to care coordination, documentation, and treatment evaluation—activities increasingly recognized in value-based and time-driven practice models. Proper reporting of 99359 affects billing accuracy and resource accounting for clinicians who provide extended indirect care.

This publication reviews coverage and usage considerations for major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise explanation of the code’s clinical scope and service setting, comparisons to the related code 99358 for the first hour of non–face-to-face prolonged services, and a summary of common implementation themes across payers.

The report provides benchmarks on how prolonged non–face-to-face time is documented and billed, highlights policy and coding nuances relevant to EHR and billing workflows, and offers clinical context for when 99359 is typically reported (for example, extended care planning, extended documentation and outcome review). Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 99359 describes prolonged non–face-to-face services provided by a clinician that involve additional time spent in preparation or evaluation of the outcome of treatment before or after a direct patient encounter. The code represents each additional 30 minutes of clinician time beyond the initial hour of such non–face-to-face prolonged services.

Service type: Prolonged non–face-to-face service (time-based, indirect patient care)
Typical site of service: Services are typically performed in an outpatient or office-based setting where clinicians conduct preparation, care coordination, documentation, or outcome evaluation outside of a direct face-to-face patient visit.

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.

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

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Billing Code Overview

Service type: Prolonged non–face-to-face service (time-based, indirect patient care)
Typical site of service: Services are typically performed in an outpatient or office-based setting where clinicians conduct preparation, care coordination, documentation, or outcome evaluation outside of a direct face-to-face patient visit.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 42-year-old patient presents to a family medicine clinic with persistent low back pain and intermittent headaches after a recent motor vehicle collision. The clinician performs a 60-minute face-to-face evaluation and management visit that includes history, examination, and initiation of a conservative care plan. The clinician then spends an additional 45 minutes on non–face-to-face activities the same day: reviewing imaging and specialist notes, coordinating physical therapy referral, documenting a detailed care plan, and communicating results with the patient by secure message. These preparation and follow-up tasks exceed the initial hour and qualify for reporting the prolonged non–face-to-face service represented by 99359 for each additional 30 minutes after the first hour. Typical workflow: face-to-face E/M encounter; immediate post-visit charting and review; ordered studies and referrals; communication with ancillary providers; patient outreach and clarification of the care plan. Typical site of service is an outpatient office or clinic where the direct encounter occurred; the additional time is documented in the medical record as non–face-to-face prolonged services on the same date of the face-to-face visit.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day of a procedure or other service	Use when the face-to-face E/M was distinct from other services on the same day and requires separate reporting in addition to prolonged non–face-to-face time
`26`	Professional component	Use when billing only the professional component and technical component billed separately by another entity
`52`	Reduced services	Use when the prolonged service was partially reduced or abbreviated and full service was not furnished
`53`	Discontinued procedure	Use when the planned service was started but discontinued due to extenuating circumstances (document reason)
`57`	(Not in provided list)	Data not available in the input.
`78`	Unplanned return to the operating room by the same physician following initial procedure	Use only if unrelated procedural complications require additional non–face-to-face prolonged work (rare for this code)
`80`	Assistant surgeon	Use when an assistant surgeon provided services; may be relevant when surgical planning requires prolonged non–face-to-face work
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when portions of the prolonged non–face-to-face evaluation are delivered via real-time telehealth modalities and payer accepts modifier for telehealth
`CO`	Routine variation; payer-specific modifier (Commercial)	Use per payer rules for commercial claims when required by insurer
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when applicable billing rules require distinguishing assistant provider roles
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use only if anesthesia direction responsibilities contribute to additional non–face-to-face time (rare overlap)
`QX`	CRNA service: with medical direction by physician	Use when applicable for billing of anesthesia services that intersect with prolonged care coordination
`XU`	Unusual non-overlapping service by the same physician or group	Use when the non–face-to-face prolonged service is distinct and not overlapping with other billed services by the same practitioner

Taxonomy Code	Specialty	Notes
`207R00000X`	Internal Medicine Physician	Common primary care provider performing E/M and care coordination leading to prolonged non–face-to-face time
`207Q00000X`	Family Medicine Physician	Frequently delivers comprehensive outpatient E/M visits with subsequent prolonged documentation and coordination
`208D00000X`	General Practice Physician	May provide broad-scope outpatient care with associated non–face-to-face prolonged activities

Note: Only the most clinically relevant modifiers from the provided list are shown. Use payer-specific guidance for modifier application and sequencing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z71.1`	Person with feared health complaint in whom no diagnosis is made	Patients with medically unexplained symptoms may require extended review and follow-up outside the face-to-face visit, justifying prolonged non–face-to-face time
`R53.83`	Other fatigue	Fatigue is a common symptom requiring review of labs, coordination of testing, and extended documentation after the visit
`F41.9`	Anxiety disorder, unspecified	Anxiety often necessitates care coordination, medication review, and patient counseling that extend beyond the direct encounter
`M54.5`	Low back pain	Low back pain frequently requires imaging review, specialist referral, and therapy coordination contributing to prolonged non–face-to-face work
`R51`	Headache	Headache evaluation may prompt review of imaging, specialty input, and extended documentation outside the face-to-face visit

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99358`	Prolonged service on date other than the face‑to‑face evaluation and management service without direct patient contact; first hour.	Used when additional non–face-to-face prolonged work occurs on a different date than the face-to-face E/M; pairs conceptually with `99359` which represents subsequent 30‑minute increments

CPT 99358: Prolonged Pre- or Post-Encounter Evaluation

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.

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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 a procedure or other service	Use when the face-to-face E/M was distinct from other services on the same day and requires separate reporting in addition to prolonged non–face-to-face time
`26`	Professional component	Use when billing only the professional component and technical component billed separately by another entity
`52`	Reduced services	Use when the prolonged service was partially reduced or abbreviated and full service was not furnished
`53`	Discontinued procedure	Use when the planned service was started but discontinued due to extenuating circumstances (document reason)
`57`	(Not in provided list)	Data not available in the input.
`78`	Unplanned return to the operating room by the same physician following initial procedure	Use only if unrelated procedural complications require additional non–face-to-face prolonged work (rare for this code)
`80`	Assistant surgeon	Use when an assistant surgeon provided services; may be relevant when surgical planning requires prolonged non–face-to-face work
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when portions of the prolonged non–face-to-face evaluation are delivered via real-time telehealth modalities and payer accepts modifier for telehealth
`CO`	Routine variation; payer-specific modifier (Commercial)	Use per payer rules for commercial claims when required by insurer
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when applicable billing rules require distinguishing assistant provider roles
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Use only if anesthesia direction responsibilities contribute to additional non–face-to-face time (rare overlap)
`QX`	CRNA service: with medical direction by physician	Use when applicable for billing of anesthesia services that intersect with prolonged care coordination
`XU`	Unusual non-overlapping service by the same physician or group	Use when the non–face-to-face prolonged service is distinct and not overlapping with other billed services by the same practitioner

Taxonomy Code	Specialty	Notes
`207R00000X`	Internal Medicine Physician	Common primary care provider performing E/M and care coordination leading to prolonged non–face-to-face time
`207Q00000X`	Family Medicine Physician	Frequently delivers comprehensive outpatient E/M visits with subsequent prolonged documentation and coordination
`208D00000X`	General Practice Physician	May provide broad-scope outpatient care with associated non–face-to-face prolonged activities

Note: Only the most clinically relevant modifiers from the provided list are shown. Use payer-specific guidance for modifier application and sequencing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z71.1`	Person with feared health complaint in whom no diagnosis is made	Patients with medically unexplained symptoms may require extended review and follow-up outside the face-to-face visit, justifying prolonged non–face-to-face time
`R53.83`	Other fatigue	Fatigue is a common symptom requiring review of labs, coordination of testing, and extended documentation after the visit
`F41.9`	Anxiety disorder, unspecified	Anxiety often necessitates care coordination, medication review, and patient counseling that extend beyond the direct encounter
`M54.5`	Low back pain	Low back pain frequently requires imaging review, specialist referral, and therapy coordination contributing to prolonged non–face-to-face work
`R51`	Headache	Headache evaluation may prompt review of imaging, specialty input, and extended documentation outside the face-to-face visit

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99358`	Prolonged service on date other than the face‑to‑face evaluation and management service without direct patient contact; first hour.	Used when additional non–face-to-face prolonged work occurs on a different date than the face-to-face E/M; pairs conceptually with `99359` which represents subsequent 30‑minute increments

CPT 99358: Prolonged Pre- or Post-Encounter Evaluation

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

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Billing Code Overview

National Reimbursement Benchmarks

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OpenPayer

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

Sign up for cpt 99359 policy alerts

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