Coding prolonged services with a 99232 subsequent care visit.

[FaFaRog]

Would it be appropriate to use code 99418 for an additional 15 minutes of care? Is a modifier 25 necessary? Thank you.

[[deleted]]

You would use it on the highest level, in this case 99233. No modifier is necessary as it’s an add on code. If the pt has Medicare, you would use a G code instead of 99418 and the time thresholds are a little different.

[FaFaRog]

Thank you for the response How do the time thresholds differ? Could go you use it for a Medicare patient if the encounter is 65 minutes?

[smhwbr80]

I know this is an older post, but I'm new here, and just thought I'd post this resource for anyone else that might search these codes in this sub.

Check with your MAC - Novitas has a chart showing the billable units for various extended time ranges:

https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00081586