CPT Codes for ECP Clinicians

This page is made available for the use by ECP clinicians. Its purpose is to assist them in correctly coding their encounters with patients in Nursing Facilities and Rest Homes (a/k/a rest homes, homes for the aged, and assisted living facilities). Codes displayed are pertinent to ECP and its practice, and while public information, are not intended for the use by any other parties.

Requires Acrobat Reader

• NEW - Medicare Nursing Home CPT Code Utilization Rate – 2006 & 2007
  - This Graph shows a frequency distribution of codes in the CPT series 99304-99318 paid by Medicare in 2006 & 2007. This doesn’t indicate whether the services billed would have met the requirements for payment if subjected to Medical Review. However, this does provide guidance to providers about a CMS reviewer’s expectations of ‘normal’ provider behavior. A provider whose frequency distribution shows significantly greater utilization of the higher paying codes (99306, 99309, & 99310) should verify clinical notes for those codes conform to their Medicare Carrier’s review standards.



• 2009 Rate Changes Physician Codes NP / PA Codes - A tool to help guide staff in code changes in 2008.



• 2008 Code Change Matrix - A tool to help guide staff in code changes in 2008.



• Use of Prolonged Service codes CPT 99354-99357 The CPT manual recognizes that there are occasions where a patient’s problem(s) are so severe and/or complex that the standard amount of time estimated for a given code is entirely inadequate. In these select circumstances, the use of ‘prolonged service’ codes is permitted. This link is to the CMS transmittal R1490CP (issued 4/11/08) which will revise their on line Claims Processing Manual. This transmittal expands the use of prolonged service codes to the E&M Code series used in Nursing Homes (99304-99310). From the introduction of this code series, in 2006, thorough 2007, there were no associated time values for the codes. The AMA adopted time values for the 2008 definitions of these codes and this transmittal ‘manualizes’ that change. 

  Clinicians using these codes to charge for ‘counseling and/or Coordination of Care’ have special requirements:

  • 50+% of the encounter must be devoted to ‘counseling and/or Coordination of Care’ – this must be documented in the encounter note
  • The underlying E&M code must be the highest available in the series (e.g. 99310) – that code’s average time is subtracted from the total visit time (e.g. 35 minutes)
  • The balance of time must be at least 30 minutes – if so it can be rounded up to charge for 1 hour of prolonged service (e.g. 99356) – additional time, in 30 minute increments may be added (see instructions)
  • Both the Start and Stop time for the visit must be documented in the clinical record.



• 2008 Code Change Matrix - A tool to help guide staff in code changes in 2008.