CPT 99354 Is Deleted: What to Bill Instead (2026)

• CPT Codes
• 99354

CPT 99354 Is Deleted: What to Bill Instead (2026)

99354 and 99355 were deleted. The replacement codes — G2212, 99417, 99418 — with time rules, payer differences, and how to fix legacy claims.

Quick Reference

Code

99354

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Updated

Jun 11, 2026

Reading Time

12 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

CPT 99354 Status: Deleted — Do Not Bill on Current Dates of Service

CPT code 99354 — the prolonged service add-on for the first hour beyond a primary visit — no longer exists in the CPT code set, and neither does its companion add-on 99355. If you are about to submit 99354 on a current claim, stop: it will deny as an invalid procedure code. The deletion happened in two stages. Medicare stopped recognizing 99354 with office and outpatient E/M visits when CMS created HCPCS code G2212, effective January 1, 2021, under the CY 2021 Physician Fee Schedule final rule. The AMA then deleted 99354 and 99355 entirely in the 2023 CPT restructuring of the prolonged services family, which consolidated prolonged care reporting around 99417 and the new 99418.

This page exists to answer the question that matters now: what do you bill instead — by setting, by primary service, and by payer — plus how to clean up legacy 99354 claims and stop the code from resurfacing in your EHR.

What to Bill Instead of 99354: Crosswalk Table

The replacement is not one code. It depends on what the prolonged time was attached to and who the payer is.

Two things make this table the difference between payment and denial. First, the Medicare and CPT versions are not interchangeable — G2212 on a commercial claim or 99417 on a Medicare claim is a denial in most cases (some Medicare Advantage and commercial plans follow CMS rules; check the payer manual). Second, prolonged codes only attach to the highest-level primary code — you cannot append G2212 to a 99214; you must first qualify for 99215 on time, then count beyond it.

Why 99417 and G2212 Count Time Differently

This is the single most-confused point in prolonged-service billing, and it exists because CMS disagreed with the AMA’s counting convention when CPT 99417 debuted.

Worked example (fictional): A psychiatric nurse practitioner spends 65 total minutes on an established-patient medication management visit on the date of the encounter — reviewing records, face-to-face evaluation, and documentation. For a commercial payer following CPT rules, that supports 99215 + 99417 × 1 (65 ≥ 55). For Medicare, the same 65 minutes supports only 99215 — G2212 is not billable until minute 69. Four minutes of difference, two different claims. Billing teams that hard-code one threshold into their charge logic get systematic denials from the other payer class.

The discrepancy also changes what “good documentation” means. Under the old 99354, a note could say “visit extended approximately 35 minutes beyond the typical service” and survive. The successor codes are threshold codes against total time: the note needs the full minute count for the date of the encounter, because whether the claim includes a prolonged unit at all turns on whether that number is 65 or 69. Total time on every level-5 visit — stated as a number, not a range — is the single documentation habit that makes both payer rule sets workable from one note.

• CPT rule (99417): prolonged time starts after the minimum total time of the level-5 code. 99215 has a CPT time range of 40–54 minutes, so under CPT logic the first unit of 99417 is reportable at 55 minutes of total time (40 + 15).
• CMS rule (G2212): prolonged time starts after the maximum total time of the level-5 code. For 99215, that means the first unit of G2212 is not reportable until total time reaches 69 minutes (54 + 15).

Handling Legacy 99354 Claims

Facilities carry this risk at a scale solo practices don’t: one stale charge master entry multiplied across dozens of clinicians produces a denial pattern, and sometimes a recoupment.

Old dates of service. 99354 remains valid for the dates when it was active. A claim for a 2022 office-visit date of service that legitimately included prolonged time may still be billed, corrected, or appealed with 99354 where the payer’s timely-filing rules allow. Keep the documentation standard that always applied: total face-to-face time, what was done, and why it exceeded the typical service.

Retroactive denials and recoupments. If a payer retroactively denies or recoups previously paid 99354 claims, check the date of service first. For dates when the code was active and the payer’s own fee schedule listed it, you have an appeal posture: the code was valid at the time of service, and the payer’s published policy at that time controls. For dates after deletion, the recoupment is correct — recode to the successor code if the documentation supports its (different) time threshold and submit a corrected claim.

A triage workflow for the denial in front of you. When a 99354 denial lands in the work queue, the same five questions resolve it every time:

Cleaning 99354 out of your systems. The recurring source of post-2023 denials is not coder error — it’s stale defaults. Audit and remove 99354/99355 from:

• Check the date of service. Pre-deletion DOS → this is an appeal/resubmission question under that year’s rules. Post-deletion DOS → recode, never appeal.
• Identify the primary service on the claim. Office/outpatient E/M, inpatient E/M, or psychotherapy? The successor code family follows the primary service, not the deleted code.
• Identify the payer’s rulebook. Medicare and payers that follow CMS rules → G-codes with maximum-time thresholds; CPT-following commercial payers → 99417/99418 with minimum-time thresholds. When in doubt, the payer’s prolonged-services policy page settles it — keep the link in the denial-workflow notes.
• Re-check the time documentation against the successor code’s threshold. This is the step billers skip: documentation that supported 99354’s old 30-minutes-beyond rule does not automatically support G2212’s 69-minute floor on a 99215. If the documented minutes don’t reach the new threshold, there is no prolonged code to recover — bill the level-5 E/M alone and move on.
• Submit a corrected claim, then fix the source. A recoded claim that doesn’t trigger the charge-master cleanup below will be back in the queue next week with a different patient’s name on it.

• the charge master / charge description master (CDM)
• superbill and encounter-form templates
• EHR “favorites,” quick-pick lists, and order sets clinicians select from
• fee schedules and contract loads that still map the code
• claim-scrubber rules that were written to allow it rather than flag it

What 99354 Was: Historical Reference

For records review, audits, and legacy appeals, here is what 99354 meant while it was active — past tense throughout.

99354 was an add-on code reporting the first hour of prolonged service beyond the typical time of a primary E/M or psychotherapy service in the office or outpatient setting. It required at least 30 minutes of time beyond the primary service’s typical time before it could be reported — the full hour did not need to elapse — and 99355 reported each additional 30 minutes after the first prolonged hour. It could not be billed alone; it attached to qualifying primary codes such as office/outpatient E/M visits and, in earlier years, psychotherapy services. Documentation had to record total time, the time the prolonged service began and ended or total duration, and the medical necessity for exceeding the typical service — see medical necessity for how payers evaluate that standard.

If you encounter “99354 time requirements” in an old payer manual, internal policy, or audit workpaper, read it as historical context for legacy dates of service only.

Behavioral Health Scenarios Under the New Codes

Long therapy session, no crisis. A standalone psychotherapy session that runs 90 minutes is still 90837 — it covers 53 minutes and up with no ceiling, and no prolonged add-on applies. The deleted 99354 was never a clean fit here, and its successors are explicitly E/M-anchored.

Crisis-adjacent long sessions. If the session is long because the patient is in acute crisis — active suicidality, acute psychosis, severe trauma response — the correct family is 90839 for the first 60 minutes plus 90840 per additional 30 minutes, not a prolonged code. Choosing 90837 + nothing for a 2-hour crisis stabilization undercodes the work; choosing a prolonged E/M code misrepresents it.

Extended psychiatric evaluations. A diagnostic evaluation that runs long is still 90791 or 90792 — untimed codes with no prolonged add-on. If the intake turns into a crisis encounter, the crisis codes may apply instead.

Long medication-management visits at facilities. This is where the successor codes actually live in behavioral health. An MAT induction visit or complex med-management encounter that consumes 70 minutes of a psychiatrist’s day supports 99215 on time, plus G2212 (Medicare, at 69+ total minutes) or 99417 (commercial, at 55+ total minutes). When the same visit includes a psychotherapy add-on like 90838, the time attributed to psychotherapy must be carved out of the E/M time before any prolonged threshold is counted — double-counting the same minutes across both code families is a classic audit finding.

Intake days that run long. A facility admission day can stack a 90791 (therapist), a 90792 (psychiatrist), and case-management time. None of it reaches a prolonged code: the eval codes are untimed, and the successor prolonged codes attach only to E/M services. If the psychiatric evaluation visit is instead structured and billed as a high-level E/M with time documentation, the G2212/99417 math can apply — but that is a different code architecture for the encounter, chosen before the visit, not a recode after it runs long.

The mixed-panel group practice. A behavioral health group billing Medicare, Medicare Advantage, Medicaid MCOs, and commercial plans cannot run one prolonged-services rule. The same 70-minute psychiatric visit might support 99215 + G2212 (traditional Medicare), 99215 + 99417 (CPT-following commercial), or 99215 alone (an MA plan that follows CMS counting but the visit only hit 65 minutes). Practical setup: configure the claim scrubber with both threshold rule sets keyed to payer class, require total time on every level-5 visit note, and audit a sample of prolonged-code claims quarterly against the payer-correct threshold — the error pattern is almost always systematic (one threshold hard-coded for everyone), not random.

Telehealth. Prolonged-code telehealth status follows the primary E/M service and the current-year CMS telehealth list; verify both the base code and the prolonged add-on appear for the date of service.

For current Medicare payment on G2212 and the successor codes, use the Medicare Physician Fee Schedule lookup tool — rates change annually and by locality, and this page intentionally does not freeze a dollar figure for a code whose predecessor outlived its own rate table.

Multi-provider facilities juggling CPT-vs-CMS thresholds, charge-master hygiene, and corrected-claim workflows are exactly where billing automation earns its keep. See how ’s RCM platform handles behavioral health claims end to end, or request a demo.

Related Billing Codes

• 99213
• 99214
• 99215
• 99355
• 99396
• 99406

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