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Billing for Prolonged Services

Wednesday, March 8, 2023

Prolonged services are time-based and involve a single same-day evaluation/management encounter. Please review these changes to TRICARE’s prolonged services billing process.

Use HCPCS Code G2212 

To align TRICARE policy with Medicare policy, providers should use HCPCS code G2212 (each additional 15 minutes, but not less than 15 minutes), when billing for prolonged services in addition to Current Procedural Terminology (CPT®) codes 99205, 99215 or 99483.

Additionally, be sure to clearly document the amount of time spent with a patient – including encounter start and stop times –  in the patient’s medical record and provide this information when submitting the claim to Health Net Federal Services, LLC (HNFS). This will help shorten the amount of time needed to process the claim.

Do Not Use CPT Code 99417

The No Government Pay Procedure Code List includes CPT code 99417. As such, HNFS will reject claims that list CPT code 99417 as an add-on for prolonged services.

For more information on claims visit our Claims page.