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Billing update: Prolonged services capped at 2 hours

With the unbundling of non-face-to-face prolonged service codes (99358, 99359) this year, you gained a brand new way to get paid for the work you do behind the scenes. But don't get dreams of going hog-wild -- you'll be limited to reporting two hours total.
Effective April 1, a medically unlikely edit (MUE)  will cap the number of times you can claim add-on code 99359 per day at two units. Because 99359 reflects 30 minutes of care in addition to the hour of care for 99358, that leaves you with a total reporting maximum of two hours.
Should you conduct two hours of work and report the non-face-to-face services to the fullest extent possible, that leaves you with an incoming payment of about $223, according to national estimates. That's not bad for the extra leg work you're conducting, especially considering that such work heretofore went unpaid.
The reporting cap is a way for CMS to provide an automatic check on medical necessity, as we reported in a recent issue of Part B News. Of course, the MUE update isn't the only billing limitation you'll face with 99358 and 99359. For instance:
Part B News is monitoring the roll-out of the prolonged service codes and will keep you updated as billing reports trickle in. Remember that you can get a game plan for prolonged services during the 3/28 live event with coding expert Maxine Lewis.
If you have any tips or feedback to share, contact Part B News today.
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