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See a sample rate comparisonCPT 99359 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Prolonged Evaluation And Management Service Beforeand/Or After Direct Patient Care; Each Additional 30 Minutes (List Separately In Addition To Code For Prolonged Service) /Family); Each Additional 30 Minutes (List Separately In Addition To Code For Prolonged Physician Service)
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Prolonged Services |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day Q5 - Service furnished by a substitute physician under a reciprocal billing arrangement |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99359 |
| Medicaid Fee Schedule | $37.60 median of the 8 states in the free preview · View Medicaid rates for 99359 |
National average reimbursement for CPT 99359 by major payers:
$60.67
$63.48
$59.14
$73.91
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CPT 99359
5 of 25 sample ratesHigher to lower in this preview
Billy Gao
Sutter Bay Medical Foundation
$159.86Published rateShire Chaudhry
Kelsey-Seybold Medical Group PLLC
$116.00Published rateGabriel Ortiz-Varela
Methodist Hospital
$83.98Published ratePankaj Satija
Pain And Headache Centers Of Texas PLLC
$54.72Published rateSure Care Health Associates PA
$41.68Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99359 vs. Other Prolonged Services Codes
The CPT 99359 code is part of the Evaluation and Management services used for Prolonged Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99359 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99291-CPT | Moderate | Critical Care Evaluation And, Critical Care Evaluation And Management Of The Unstablecritically Ill Or Unstable Critically Injured Patient Requiring The Constant Attendance Of The Physician First |
| 99292-CPT | Low | Critical Care Addl 30 Min, Critical Care Evaluation And Management Of The Critically Ill Or Critically Injured Patient; Each Additional 30 Minutes (List Separately In Addition To Code For Primary Service) |
| 99358-CPT | Low | Prolonged Evaluation And Management Service Beforeand/Or After Direct Patient Care; First Hour Eg Review Of Extensive Records And Tests Communication With Other Professionals And/Or The Patient/Family); First Hour (List Separately In Addition To Code(S) For Other Physician Service(S) And/Or Inpatient Or Outpatient Evaluation And Management Service) |
| 99359-CPT | Low | Prolonged Evaluation And Management Service Beforeand/Or After Direct Patient Care; Each Additional 30 Minutes (List Separately In Addition To Code For Prolonged Service) /Family); Each Additional 30 Minutes (List Separately In Addition To Code For Prolonged Physician Service) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99359. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99359 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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