CPT 99354 Still Active
CPT code 99354 worked for the prolonged service by Current Procedural Terminology (CPT). During it active form, it needed to be invoiced with the proper procedure code and could not be billed alone. CPT code 99354 belonged to the subgroup of prolonged services codes. These prolonged services group was made up of add-ons from 99354 to 99359.
Several Licensed Professional Counselors (LPC), Licensed Marriage Family Therapist (LMFT), Licensed Clinical Social Workers (LCSW), psychiatrists and clinical psychologists can get their reimbursement with 99354. Before 2023, this code was exclusively billed by medical professionals using Evaluation and Management (E/M) codes. But, throughout the past few years, numerous insurers have started to compensate for it using ordinary service codes.
CPT 99354 Code Reimbursement
Here are the following lists of CPT 99354 Code Reimbursement
An extra hour and forty-five minutes for a diagnostic examination
- CPT Add-On Code +99354 Reimbursement Rate (2022): $140.26
- CPT Add-On Code +99354 Reimbursement Rate (2020): $132.09
- CPT Add-On Code +99354 Reimbursement Rate (2021): $129.10
- Extra time for a diagnostic assessment up to three hours (must be used with +99354)
Extra time for a diagnostic assessment up to three hours (must be used with +99354)
- CPT Add-On Code +99355 Reimbursement Rate (2022): $101.32
- CPT Add-On Code +99355 Reimbursement Rate (2020): $100.33
- CPT Add-On Code +99355 Reimbursement Rate (2021): $96.31
Reimbursement for 99354 varies widely and is primarily contingent upon the insurance provider. When it is, the fee structure frequently permits reimbursement in accordance with 90837.
CPT 99354 Description
According to the 99354 description, an extra 30-74 minutes beyond the other CPT code. This indicates that 99354 cannot be billed for a specific period of time. Thus, it is crucial to note the original process code time plus at least half an hour.
CPT 99354 Time Length
The 99354 is nearly always invoiced with 90837 or 90847 for mental health providers. Sessions must last at least thirty minutes longer than the other process code since 99354 requires at least an extra 30 minutes. 90847 can provide 50 minutes and 90837 provides 60 minutes services.
CPT Code for Billing Individual Psychotherapy: 99354
53-89-minute session when involving the code 90837
90-134-minute session with the combination of 90837 + 99354.
Psychotherapy in Group with the Patient Present
26-79 minutes session when involving 90847
80-124 minutes session with the combination of 90847 + 99354.
Reimbursement for 99354 varies widely and is primarily contingent upon the insurance provider. When it is, the fee structure frequently permits reimbursement in accordance with 90837.
CPT 99354 Add on Code
An Add-on Code (AOC) is a CPT / Healthcare Common Procedure Coding System (HCPCS) code that designates a service made in cycle with the main service provided by the same practitioner.
The first hour of sustained service on a given date is reported using either 99354 or 99356, based on the location of service. Each service date, only one of these codes may be utilized. In order to report either one of these codes services, the provider counselling must last for at least 30 minutes after the E & M code’s regular time.
CPT 99354 and 99355
Underbilling insurance is not always mandatory for the psychotherapy sessions that lasts more than 134 minutes for an individual. It is same for a group for more than 124 minutes. For sessions lasting an additional thirty minutes, 99355 and 99354 are capable of being employed in conjunction. Both codes are part of the same subgroup of process codes. 99354 is required in order to bill 99355. If the sessions be much longer, you would also bill 99355.
CPT 99354 in 2023
As of 2022, CPT code 99354 was utilized for extended care in an outpatient environment. This code is no longer in usage. This code was eliminated since January 1, 2023. CPT code 99354 has now been replaced with CPT add-on code + 99418.
CPT 99354 Effective Date
Provider code panel removed the CPT 99354 Code and replaced it with CPT 99418 as per the American Medical Association (AMA). The code PT 99354 was effective until January 1, 2023.
Is CPT 99354 Still Valid?
No, CPT 99354 is not valid now. This code was replaced with CPT 99417. Now, prolonged services can be reported using code 99417 in addition to 99245. These codes can now be used for new or current patient’s office visit or other related outpatient consultations.
Here is the list of some CPT codes that are not valid now:
- CPT code 99354
- CPT code 99355
- CPT code 99356
- CPT code 99357
What CPT Code Replaced 99354?
CPT code 99417 has replaced the code 99354. Codes 99417 and 99345 can be used to to gain prolonged services. The prolonged services include an outpatient session or a visit to the provider clinic for a fresh or existing patient.
What Does CPT Code 99354 Mean?
CPT code 99354 was implemented for prolonged treatment of patients by a doctor or other qualified health care provides. These services can be in an inpatient or outpatient environment. The level of care goes beyond the boundaries of the typical service and include direct (face-to-face) connection with patients.
For instance, CPT Code 99354 was used to charge for longer sessions with direct patient engagement in a variety of healthcare settings, including mental health therapists. However, CPT code 99354 and CPT code 99355 are not valid since 2023. Therefore, these codes are no longer used for billing or reimbursement.
What Is CPT Code 99354?
According to American Medical Association, CPT Code 99354 is utilized for prolonged healthcare services. It also includes t services that go above and beyond the routine time duration. This code is charged for a particular appointment for prolonged care services to the patients and involves direct patient contact. Services delivered in non-office settings, including other outpatient services, fall under this service.
Can You Use CPT Codes Both 90838 and 99354?
It is true that you can use CPT code 90838 and CPT code 99354 together under the right conditions. CPT code 90838 serves for the patient’s psychotherapy sessions of 60 minutes. CPT code 99354 serves for psychotherapy sessions for one and a half hour or even more due to its specification of prolonged therapy.
Consequently, you may bill for treatment employing 90838 and add 99354 for the additional time above 90 minutes if the therapy session lasts longer than an hour.
Does CPT 99354 Require a Modifier?
As of other CPT codes, 99354 also requires a modifier 25. 99354 and 96365 cannot be billed together without a modifier. It was assumed that add-on codes did not require modifier since they are billed with the principal code that will carry the modifier. It is advisable to add a modifier to 99354 for invoicing, according the billing information.