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

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Wendy Belding
  • Edited

[This is for informational purposes only - I am just a provider and can't offer any help, advice or service.]

As of 1/1/2023, 99354 has been deleted and is no longer a valid code.  If you bill for it, it likely will not pay.  Some providers may choose to honor it, but it's not likely. 

There are currently no "add on" codes to use with a 90837 (60-minute) for 90-minute to 120-minute sessions of which we are aware - at least for TriCare(s) and TriWest. 

If you book sessions for Prolonged Exposure Therapy or EMDR that are more than 60-minutes, there appears to be no way to get reimbursed for anything beyond the 60-minutes at this time for any extended services.  Which means that until this is settled (and perhaps a new code is designated), it's prudent to not schedule any clients longer than 60-minutes for mental health sessions (at least for TriCare and TriWest).

For TriCare and TriWest: you can only bill codes on the Authorization Letter (if there is one), however even if 99354 is on there it shouldn't pay as of 1/1/2023 (some letters are many months old and it was valid at the time).  And, if it does pay, it may possibly be recouped later.

[This is for informational purposes only - I am just a provider and can't offer any help, advice or service.]

More information:

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3 comments

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  • 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
    • Edited

    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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