Can you bill 99417 with 99215 ?

Yes, you can bill CPT code 99417 in conjunction with 99215 when the total time spent on the encounter exceeds the typical time for a level 5 established patient visit. Here’s how to apply these codes based on the total time:

99215: Represents an established patient office visit with a typical time of 40-54 minutes.

99417: Is an add-on code used to report each additional 15 minutes of prolonged service beyond the typical time of the primary E/M service.

Application Example:

If you spend a total of 70 minutes on an established patient’s visit:

Determine the base service: The first 40-54 minutes are covered by 99215.

Calculate additional time: Subtract the maximum typical time for 99215 (54 minutes) from the total time (70 minutes): 70 – 54 = 16 minutes.

Report prolonged service: Since 16 minutes exceed the 15-minute threshold, you can report one unit of 99417 for the additional time.

Coding for this scenario: You would bill 99215 for the initial 54 minutes and 99417 for the additional 16 minutes.

Important Considerations:

Time Thresholds: Ensure that the total time meets the requirements for 99215 before adding 99417. For 99417, the additional time must be at least 15 minutes beyond the typical time of 99215.

Documentation: Maintain detailed documentation of the total time spent and the specific services provided during the encounter to support the billing.

Payer Policies: Be aware that some payers, including Medicare, may have specific guidelines for reporting prolonged services. For instance, Medicare uses HCPCS code G2212 instead of 99417 for prolonged services with different time thresholds.