In the past, most payers provided benefits for direct prolonged physician services involving physician or qualified health care professional (QHP) face-to-face time in the office or outpatient setting or unit or floor time in a facility setting. However, payment for indirect (non–face-to-face) prolonged services was rare. In 2017, the Centers for Medicare & Medicaid Services (CMS) took a big step toward paying for non– face-to-face services commonly provided by physicians. Medicare will pay separately for codes 99358 and 99359, which describe prolonged services by a physician or other QHP without direct patient contact. It is likely that Medicaid plans and private payers will follow suit (although each may develop differing payment policy and reporting instructions). For this reason, pediatricians should note the requirements for documenting and reporting these services and plan now to incorporate documentation and charge capture processes.

Current Procedural Terminology (CPT®) code descriptors and...

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