Prolonged Services for Labor Management
Defines how Premera limits reimbursement for prolonged service procedure codes when billed to represent labor management, and applies to professional services billed on CMS-1500 or 837P claims across Premera and affiliated lines of business.
No material clinical or coverage changes in this revision.
Coverage Criteria for Prolonged Services
Coverage stance for prolonged services in labor management
The Plan will not separately reimburse prolonged service procedure codes billed to represent labor management when the provider billing does not perform the delivery. Prolonged service codes are considered a component of maternity delivery services.
Prolonged service codes
- +99415 Prolonged clinical staff services during an E/M in the office/outpatient setting; first hour (list separately)
- +99416 Each additional 30 minutes in conjunction with 99415
- +99417 Prolonged outpatient E/M service each 15 minutes (list separately); do not use on same date as 99415/99416/99358/99359 and certain psychotherapy codes
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