CommercialBilling CodesMedium impact
Prolonged Physician Services
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jan 1, 2021
We identified it
Jun 19, 2026
Summary
BCBSRI will not follow AMA coding guidance for commercial members regarding CPT 99417, which allows billing within the first 15 minutes of extended time. Instead, they will follow CMS guidelines where prolonged service codes 99417 and G2212 can only be billed when the maximum time for level 5 E/M visits is exceeded by at least 15 minutes.
Action Required
Immediately: Billing team must update coding practices for BCBSRI commercial members to NOT bill CPT 99417 or G2212 unless the maximum time for level 5 office/outpatient E/M visits is exceeded by at least 15 minutes. Update billing software rules and train staff on CMS prolonged service guidelines rather than AMA guidance for BCBSRI claims.