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"Prolonged Services:" 99354 is no longer a valid code - it likely won't pay / TriCare and TriWest



  • Paul Peterson

    Shoot, this is not great news. I have several clients that seem to benefit greatly from a longer session (for EMDR, those that travel 45 min for each session, etc.). 

    I'll be following this thread to see if anyone has found a good way to do 90 - 120 minute sessions. I guess the only other option right now is to have the extra time paid out-of-pocket?

    Thanks Wendy. I just got my first claim rejection with 99354 from earlier this week.

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  • Wendy Belding

    Hi Paul,

    Make certain to review your contract before charging for out-of-pocket. You may be allowed to charged the client (cash-pay) for uncovered services while billing the Insurer for covered services.  You may not, unless they become only a cash-pay client (with no services at all billed to the Insurer for that client).  Best of luck!

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  • Paul Peterson

    Great reminder. I believe my contract says I can charge for out-of-pocket for uncovered services, but I will double-check. Also, for anyone else interested, I'm in Arkansas using BCBS.

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