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    v1.0.30
    OpenPayerBilling CodesProlonged Service on Date Other Than the Face-to-Face Evaluation and Management Service Without Direct Patient ContactCPT cpt-99359-prolonged-non-face-to-face-evaluation-30-min
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    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.

    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 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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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99358Prolonged 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 which represents subsequent 30‑minute increments

    Related Modifiers

    8 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…
    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…
    57CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207R00000X
    207Q00000X
    208D00000X
    261QB0400X
    332BX2000X
    103K00000X
    163WR0006X
    385HR2065X

    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-99358-PROLONGED-NON-FACE-TO-FACE-EVALUATION

    CPT 99358: Prolonged Pre- or Post-Encounter Evaluation

    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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    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.

    99359