Billing CPT 99355 with E & M codes

CPT 99355 with E&M services

CPT-4 Code 99355 To report additional prolonged outpatient E&M services, CPT-4 code 99355 (each additional 30 minutes) must be billed in conjunction with code 99354.

Billing Calculations CPT-4 codes 99354 and 99355 are subject to the least restrictive frequency limitation as the required companion code. To calculate the amount of time that is payable for prolonged outpatient services, take the total face-to-face time and subtract the time of the primary E&M service. The following table may be used to calculate billing for prolonged outpatient E&M services.

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Time of E&M visit code not included              First hour            Each additional 30 minutes

Less than 30 minutes                                     Not reported                Not reported

30 – 74 minutes                                             99354                         Not reported

75 – 104 minutes                                           99354                         99355

105 – 134 minutes                                         99354                         99355 (quantity of 2)

135 – 164 minutes                                         99354                         99355 (quantity of 3)

165 – 194 minutes                                         99354                          99355 (quantity of 4)



Inpatient ServicesCPT-4 Code 99356 - To report prolonged inpatient E&M services, CPT-4 codes 99356 (inpatient setting; first hour) must be billed in conjunction with one of the following E&M service codes:



Description & CPT-4 Code


Initial hospital care and subsequent hospital care

99221 – 99223

99231 – 99233


Inpatient consultation

99251 – 99255


Nursing facility services

99304 – 99310

Inpatient psychotherapy with E&M component

90822, 90829