All PlansBilling CodesMedium impact
2024 September Network Connection
Presbyterian Health Plan·NM·Provider News
We identified it
Sep 1, 2024
Summary
Presbyterian's September 2024 Network Connection newsletter contains a regulatory update to CPT code +99417 (prolonged E/M services). The revision clarifies that the 15-minute initial time unit for +99417 can only be added once the primary E/M code's time threshold is exceeded by 15 minutes, and +99417 should not be reported for any time unit less than 15 minutes. This affects how providers bill for prolonged office visits and consultations.
Action Required
Billing team must review current billing practices for CPT code +99417 usage. Audit claims submitted in the past 6-12 months to identify any instances where +99417 was billed for time units less than 15 minutes, as these violate the updated guidance and may require correction or reversal. Update billing software logic and provider education materials to enforce the rule: +99417 can only be added once the primary E/M code time threshold is surpassed by 15 minutes, with a minimum 15-minute increment. Communicate this clarification to all providers and coding staff to prevent future billing errors. Monitor future submissions for compliance with the new requirements.