99417
Prolng op e/m each 15 min
Prolonged outpatient evaluation and management service, each 15 minutes of total time beyond the threshold of the primary E/M code. CMS 2026 wRVU 0.61. Commercial-payer counterpart to Medicare's G2212; cannot be billed to Medicare for the same encounter. Add-on only, never a stand-alone code.
Billing guidance for 99417 is locked
- When to use it: the exact clinical situations that support billing 99417
- Documentation checklist: the 6 elements your note needs before submitting
- Common pitfalls: the 6 mistakes that get 99417 downcoded or denied
Payer notes
Commercial payers including UnitedHealthcare, Aetna, Cigna, and most BCBS plans accept 99417 with proper documentation; reimbursement is typically the wRVU times the payer's conversion factor. Medicare and Medicare Advantage use G2212 for office and outpatient prolonged services and will deny 99417. Submit the correct prolonged-service code per payer; resubmitting a denied claim under the alternate code is allowed but slows revenue cycle. Some commercial payers require a specific place-of-service modifier; check your payer-specific guidance before billing.