What is the minimum minutes needed to reach one unit of Medicare prolonged time for a 99205?

What is the minimum minutes needed to reach one unit of Medicare prolonged time for a 99205?

• A. 74
• B. 89
• C. 60
• D. 75

Answer: (B)

The main idea here is time-based billing for prolonged services in outpatient E/M encounters. For a 99205 (new patient, high complexity), the charted “typical” time is about 60 minutes. When time spent goes beyond that, you can add prolonged-service time codes (the first unit of prolonged time corresponds to about 30 minutes beyond the usual). Because CMS counts time in minutes and uses the threshold for starting that prolonged block, the minimum total time you must document to reach one unit is 89 minutes. In other words, you need at least 89 minutes total to bill one unit of Medicare prolonged time. If you spent more time (e.g., around 119 minutes), you could add another prolonged-time unit, and so on. The other options (74, 60, 75) do not meet the required threshold beyond the base 60 minutes, so they don’t qualify for the first prolonged-time unit.

The main idea here is time-based billing for prolonged services in outpatient E/M encounters. For a 99205 (new patient, high complexity), the charted “typical” time is about 60 minutes. When time spent goes beyond that, you can add prolonged-service time codes (the first unit of prolonged time corresponds to about 30 minutes beyond the usual). Because CMS counts time in minutes and uses the threshold for starting that prolonged block, the minimum total time you must document to reach one unit is 89 minutes. In other words, you need at least 89 minutes total to bill one unit of Medicare prolonged time. If you spent more time (e.g., around 119 minutes), you could add another prolonged-time unit, and so on. The other options (74, 60, 75) do not meet the required threshold beyond the base 60 minutes, so they don’t qualify for the first prolonged-time unit.