Prolonged inpatient or observation evaluation and management service, each additional 15 minutes

Description

This code is used to bill for additional time spent by a provider on inpatient or observation evaluation and management services. It applies to each increment of 15 minutes beyond the minimum required time for the service provided.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

—

Patient Copayment / Coinsurance

—

Top Modifiers

Graph View

List View

HCPCS/CPT GCServices performed by a resident under the supervision of a teaching physician(8.3%)

HCPCS/CPT 25Significant, separately identifiable evaluation and management service on the same day(7.38%)

HCPCS/CPT FSSplit or shared evaluation and management visit(5.4%)

HCPCS/CPT GWService unrelated to hospice patient's terminal condition(3.03%)

HCPCS/CPT GVAttending physician not employed by hospice provider(2.9%)

HCPCS/CPT Q1Routine clinical service in an approved clinical research study(1.98%)

HCPCS/CPT AQService rendered in a health professional shortage area(1.98%)

HCPCS/CPT 95Telehealth service via real-time interactive audio and video telecommunications(1.71%)

HCPCS/CPT AIPrincipal physician of record modifier(1.71%)

HCPCS/CPT CRCatastrophe or disaster-related service modifier(1.19%)

Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)