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1 ago, 2021

Prolonged Physician Services

As a reminder to all providers, effective 1 de enero de 2021, BCBSRI updated the Prolonged Physician Services policy in regards to reimbursement for the new physician prolonged service codes 99417 and G2212. Claims filed for professional outpatient prolonged services (both 99417 and G2212) will be considered for reimbursement as described by Centers for Medicare & Medicaid Services’ (CMS) Prolonged Office Outpatient Evaluation and Management Reporting Times whereby, “…the time of the reporting practitioner is used to select the office/outpatient E/M visit level, HCPCS code G2212 could be reported when the maximum time for the level 5 office/outpatient E/M visit is exceeded by at least 15 minutes on the date of the service." BCBSRI will not be following the coding guidance from the AMA for Commercial members related to code 99417, which allows for submission and reimbursement consideration for the code within the first 15 min of extended time. Please ensure your billing teams regard this change when filing for prolonged services. Please refer to the medical policy for coding and other details by clicking here.

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