From the Research
For a 55-minute patient session, I recommend billing using the time-based CPT code 99215 for an established patient or 99205 for a new patient, as these codes are appropriate for visits lasting between 40-54 minutes of face-to-face time, and adding the prolonged service code +99417 to account for the additional time beyond the base code, as supported by the general medical knowledge and guidelines, although not directly mentioned in the provided studies 1, 2, 3, 4, 5. The provided studies do not directly address the question of billing for a 55-minute patient session, but based on general medical knowledge and guidelines, time-based billing is an appropriate approach.
- The CPT code 99215 is used for established patients, and 99205 is used for new patients, for visits lasting between 40-54 minutes of face-to-face time.
- Since the session slightly exceeds this timeframe at 55 minutes, adding the prolonged service code +99417 can account for the additional time beyond the base code.
- When documenting this visit, it is essential to clearly record the total time spent with the patient, including face-to-face time and any time spent on the same day reviewing records, ordering tests, or coordinating care.
- Time-based billing requires that more than 50% of the visit time be spent on counseling and coordination of care, as stated in the 2021 E/M guidelines, which allow billing based on either total time or medical decision-making complexity, giving providers flexibility to select the most appropriate method for each encounter.