Billing for Prolonged Services: Corrected Information for CPT® Code 99417
Tuesday, August 22, 2023
Health Net Federal Services, LLC (HNFS) provided details on changes to TRICARE’s prolonged services billing process in our March 2023 educational piece titled “Billing for Prolonged Services.” In that piece we stated Current Procedural Terminology (CPT®) code 99417 was included in TRICARE’s No Government Pay Procedure Code List. TRICARE has since decided not to add CPT code 99417 to the No Government Pay Procedure Code List. However, TRICARE will not accept CPT code 99417 as an allowable code for prolonged services, and providers should use more appropriate codes.
Please review the following corrected information. We apologize for any confusion our previous communication may have caused.
Corrected Information
Prolonged services are time-based and involve a single same-day evaluation/ management encounter. To align TRICARE policy with Medicare policy, in addition to CPT codes 99205, 99215 and 99483, providers should use HCPCS code G2212 (each additional 15 minutes, but not less than 15 minutes), when billing for prolonged services.
Clearly document the amount of time spent with a patient in the medical record and associated claim. Including this information in the medical record and claim submission will help shorten the amount of time needed to process the claim. Be sure to include:
- Encounter start and stop times and/or
- Total time spent with patient
TRICARE does not accept CPT code 99417 as an allowable add-on code for prolonged services. Claims listing this code will reject for a corrected procedure code.
Visit our Prolonged Services Billing page for more information.
