CPT 99417 is the add-on code for prolonged office or outpatient visits. It is reported for each full 15 minutes of total time beyond the time required for 99205 or 99215, when the visit level was chosen by time. Medicare does not accept 99417 and uses HCPCS code G2212 instead, with different thresholds.
CPT 99417 description
99417 is a prolonged outpatient evaluation and management service, each 15 minutes of total time beyond the required time of the primary service. For office visits, it is added to 99205 (new patient) or 99215 (established patient), and only when the primary code was selected by time, not by medical decision making.
When 99417 starts: CPT vs. Medicare
| Total time on the date of the visit | Most commercial payers (CPT) | Medicare |
|---|---|---|
| Established patient | 99215 at 40–54 min; 99215 + 99417 ×1 at 55–69 min; ×2 at 70–84 min | 99215 at 40–68 min; 99215 + G2212 ×1 at 69–83 min; ×2 at 84–98 min |
| New patient | 99205 at 60–74 min; 99205 + 99417 ×1 at 75–89 min; ×2 at 90–104 min | 99205 at 60–88 min; 99205 + G2212 ×1 at 89–103 min; ×2 at 104–118 min |
Medicare thresholds are from the CMS Evaluation and Management Services guide (MLN006764) (opens in a new tab). The difference exists because Medicare counts prolonged time from the end of the old 99205 and 99215 time ranges rather than from their minimums.
What counts toward the time
The same total time as the primary visit: the practitioner’s time on the date of the visit, face-to-face or not, including:
- Preparing to see the patient, such as reviewing tests
- Getting or reviewing separately obtained history
- Performing a medically appropriate exam
- Counseling and educating the patient, family or caregiver
- Ordering medications, tests or procedures
- Referring and communicating with other professionals (when not separately reported)
- Documenting in the record
- Independently interpreting results (when not separately reported) and coordinating care
Clinical staff time and time on other days do not count.
Common 99417 mistakes
- Billing it to Medicare: use G2212 for Medicare patients.
- Adding it to 99214 or 99204: it only follows the highest level, 99215 or 99205.
- Choosing the level by MDM: 99417 requires the primary code to be chosen by time.
- Partial units: report it only for each full 15 minutes.
- No time in the note: document the total minutes, and ideally what filled them.
Frequently asked questions
Does every commercial payer accept 99417?
Most follow CPT, but some adopt Medicare’s G2212 approach. Check each payer’s policy.
Is 99417 used outside the office?
CPT also allows it with certain other E/M services. This guide covers office and outpatient visits.
Related guides
- CPT 99213: low-complexity established visit
- CPT 99214: moderate-complexity established visit
- 99213 vs. 99214: how to choose the level
- CPT 99215: high-complexity established visit
- CPT 99204: moderate-complexity new patient visit
- CPT 99203: low-complexity new patient visit
- CPT 99205: high-complexity new patient visit
- CPT 99212: straightforward established visit
- CPT 99202: straightforward new patient visit
- CPT 99211: nurse visit for an established patient
- Primary care billing services
- Medical coding services
CPT is a registered trademark of the American Medical Association. This guide summarizes the office visit E/M rules in effect since 2021, with the 2024 time wording, and the CMS Evaluation and Management Services guide (MLN006764) (opens in a new tab). Payer policies and your documentation decide what is billable.
Long visits, no extra payment?
We make sure prolonged visits are documented and billed with the right add-on for each payer.