Since the California Division of Workers’ Compensation (DWC) adopted the 2017 Physician Fee Schedule for dates of service on or after March 1, the DaisyBill team has fielded hundreds of questions from providers across the state. A great many of these questions focused on a pair of newly-reimbursable CPT codes – 99358 and 99359 – for non-face-to-face prolonged services, including but not limited to record review. Today, we answer your questions and unveil our newest California workers’ comp billing resource: A detailed 99358 & 99359 Resource Notebook.
Say a provider agrees to treat an injured worker. To better inform their treatment, this provider is sent medical records from other providers. These records are disorganized, perhaps incomplete, and contain multitudes of irrelevant information that has no direct bearing on the current case. So the provider digs in and studies the information on his or her own time, sifting through the records to uncover any pertinent information. They are undeniably providing a service – a better-informed provider will create a better treatment plan.
Starting for all dates of service in 2017, Medicare recognizes the need to reimburse providers for this additional non-face-to-face care provided to patients. With the adoption of Medicare’s new RVU17A files, effective for all dates of service on or after March 1, 2017, the California DWC also adopted reimbursing workers’ comp providers for this additional non-face-to-face prolonged service without direct patient contact.
99358 & 99359 Resource Notebook: A detailed guide to reporting these codes, including analysis of CPT guidelines, a cheat-sheet for knowing how many units to report, and a supporting documentation checklist.
Webinar Slides: Full slides from our March 28 presentation on reporting 99358 and 99359.
99358 / 99359 FAQs
Let’s move on to some frequently asked questions about these two CPT codes.
Q: Were you able to bill these codes for services prior to March 1st, 2017?
A: Technically, yes. But practically, no. You could bill for these services, but there was no specific reimbursement due because both 99358 and 99359 were previously assigned Status Code B. Payment for codes with Status Code B is always bundled into payment for other services. As of March 1, 99358 and 99359 are assigned Status Code A, and are therefore separately reimbursable.
Q: Can these codes be used in conjunction with CPT 99444 for non-face-to-face online medical evaluation?
A: No. 99444 is one of the incompatible codes with which you may not report 99358 or 99359. For more information about incompatible codes, download our 99358 & 99359 Resource Notebook below.
Q: Can Qualified Medical Evaluators (QMEs) report these codes for record review?
A: No. These codes do not apply to medical-legal evaluation bills. The Medical-Legal Fee Schedule applies to reimbursement for these evaluations.
Q: What is the reimbursement amount for these two codes?
A: 99358 - $149.40 and 99359 - $71.96
Q: What is the maximum time allowed per day to bill for records review? 99358 plus 99359 only cover the first 90 minutes of non-face-to-face care.
A: CPT Code 99358 can only be reported once per day, and only if the prolonged service reaches at least 30 minutes. After the first 60 minutes, 99359 is used for every subsequent half hour. There is no defined limit to how many times you can report 99359. Providers must meet half of the specified time before billing these codes. In this case, that means that a provider must spend 30 minutes or more before billing code 99358, and 75 minutes or more before adding code 99359.
Q: Are there any specific requirements for supporting these codes with documentation?
A: There are no specific reporting requirements for prolonged services. Nonetheless, we strongly recommend including documentation when prolonged services are rendered. We included a sample Supporting Document Checklist as a guideline for providers in our 99358 & 99359 Resource Notebook below.