CurrentBlue Cross Blue Shield - OklahomaPolicy CPCP024

Evaluation and Management (E/M) Coding - Professional Provider Services

Defines coding and billing guidance for prolonged E/M service CPT/HCPCS codes (with or without direct patient contact) as applied to Blue Cross Blue Shield - Oklahoma claims and related internal policy links. Affects providers billing prolonged E/M services.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyEvaluation and Management (E/M) Coding - Professional Provider Services

Policy CodePolicy CPCP024

Change TypeNo material change

Effective DateDec 4, 2023

Next Review DateN/A

Key ActionBill prolonged E/M codes only with appropriate primary E/M codes and observe prohibited same‑date combinations; report prolonged units in 15‑minute increments.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

severalprolonged service codes referenced

6policy update history entries

4related internal policy references

Prolonged E/M Coverage Criteria

Prolonged E/M billing criteria

Billing constraints and pairing rules for prolonged E/M codes.

Prolonged E/M codes must be billed in accordance with their specified relationships to primary E/M services and other prolonged-service codes as described below.

Prolonged office/outpatient codes (G2212, 99415, 99416)

G2212/99415/99416 are used to bill each additional 15 minutes beyond the total time of the primary office/outpatient E/M service (may be with or without direct patient contact).15 minutes
G2212 and similar prolonged-office codes are reported in addition to primary office/outpatient E/M codes such as 99205, 99215, and 99483 (i.e., billed in conjunction with these primary codes).

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyEvaluation and Management (E/M) Coding - Professional Provider Services

Policy CodePolicy CPCP024

Change TypeNo material change

Effective DateDec 4, 2023

Next Review DateN/A

Key ActionBill prolonged E/M codes only with appropriate primary E/M codes and observe prohibited same‑date combinations; report prolonged units in 15‑minute increments.

SourceLink

On This Page

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Prolonged E/M Codes and Time Units

Prolonged E/M codesCPT | HCPCS

99415	Prolonged office or other outpatient E/M service(s) each additional 15 minutes beyond the maximum required time (used with total time primary E/M)
99416	Prolonged office or other outpatient E/M service(s) each additional 15 minutes beyond the maximum required time (listed with 99415 in some references)
G2212	Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure; each additional 15 minutes (not reported for units less than 15 minutes).
99358	Prolonged service without direct patient contact; first hour (used before and/or after direct patient care).
99359	Prolonged service without direct patient contact; additional time units beyond first hour.
99418	Prolonged inpatient or observation E/M each 15 minutes with or without direct patient contact beyond required time of primary service.

Minimum reported time unit (threshold and unit guidance)

Minimum reported time unit15 minutes — codes that specify 15-minute increments (e.g., G2212, 99415/99416, 99418) are not reported for units less than 15 minutes.

Rounding / unit reportingReport additional time in 15-minute increments only; do not report fractional units under 15 minutes.

Applies toProlonged office/outpatient (G2212, 99415/99416) and prolonged inpatient/observation (99418) codes that require 15‑minute increments.

Billing Relationships and Provider Guidance

Billing Rule

Prolonged E/M Billing Relationships

Prolonged E/M service codes may be reported only when the service meets CPT time‑based reporting rules and is billed in conjunction with an appropriate primary E/M code. Use the total time for the primary E/M when selecting the primary code, and report prolonged service codes for each additional 15‑minute increment beyond the primary service time as allowed. Do not report prolonged service codes for time units less than 15 minutes.

Affected codes: 99418, 99358, G2212, +99417 (as +99418 in some descriptions) and related prolonged-service CPTs
Do not report prolonged service codes on the same date of service as disallowed combinations (examples: 99358/99359 with 99202–99205/99212–99215; 99358/99359 with 90833/90836/90838; G2212 should not be reported with 99358, 99359, 99415 or 99416).
Report G2212 only for office or other outpatient E/M services selected using total time and only for each additional 15 minutes beyond the maximum required time; do not report for increments under 15 minutes.
Report +99418 (prolonged inpatient/observation E/M each 15 min) in conjunction with qualifying inpatient/observation E/M primary codes (for example 99223, 99233, 99236, 99255, 99306, 99310) and not on the same date as excluded codes.
99358 is used to bill the first hour of prolonged E/M service without direct patient contact (before and/or after direct patient care) and should not be billed on the same date as 99202–99205/99212–99215.
Ensure documentation supports the total time and the additional prolonged minutes, including start/stop times or time increments and why the prolonged time was medically necessary.

Definitions for Prolonged Service Codes

99358 / 99359 — Prolonged service without direct patient contact

Codes99358 (first hour) and 99359 (additional time units)

Definition / useProlonged service without direct patient contact; 99358 used to bill the first hour of prolonged E/M service before and/or after direct patient care; 99359 for additional time units.

Same-date restrictionsThese codes should not be billed on the same date of service as 99202-99205 or 99212-99215 and other specified codes.

G2212 / 99415 / 99416 — Prolonged office/outpatient E/M each additional 15 minutes

CodesG2212, 99415, 99416

DefinitionProlonged office or other outpatient E/M service(s): each additional 15 minutes beyond the maximum required time of the primary service (used with total time primary E/M).

Billing relationshipsG2212 is listed in addition to CPT codes 99205, 99215, and 99483. G2212 should not be reported on the same date as 99358, 99359, 99415, or 99416.

99418 — Prolonged inpatient or observation E/M (15-minute increments)

Code99418

Definition / useProlonged inpatient or observation E/M: each 15 minutes with or without direct patient contact beyond the required time of the primary service when the primary service level is selected using total time.

Required primary codesUse in conjunction with inpatient/observation primary codes such as 99223, 99233, 99236, 99255, 99306, and 99310.

Same-date restrictionsShould not be billed on the same date of service as 90833, 90836, 90838, 99358, or 99359.