Fee Schedule- Help!

[Cjena6486]

Hello all.

Can someone shed some light on 99354. I could not find the fee on Medicaid's Illinois fee schedule. Any assistance would be appreciated.

Have a lovely day!

[Michele]

99354 is for prolonged E#&M or psychotherapy services, for the first hour.  If it is not on the fee schedule then my guess is that IL Medicaid doesn't cover prolonged services.

[Cjena6486]

Thank you! You were right it is not a covered code. Do you have any suggestions on how to bill or not bill this. Would I leave it off the claim co pletely or bill it with a zero charge?

[medwave]

In the office or other outpatient setting, Medicare will pay for prolonged physician services (CPT code 99354) (with direct face-to-face patient contact that requires one hour beyond the usual service), when billed on the same day by the same physician or qualified NPP as the companion evaluation and management codes.

[Cjena6486]

I am questioning Molina Medicaid- (follows Medicaid guidelines & fee schedule)

[Michele]

You can bill it, with a charge or without, as long as you write it off after processed and do not bill the patient.

[michaelharris99]

Thank you @Midwave it's helpful.