Prolonged Services: Billing 99417 and G2212 the Right Way
When a long visit runs past the top E/M level, prolonged-service codes capture the extra time — but Medicare and commercial payers count the clock differently. Here is when to use G2212 vs 99417 and the exact thresholds.
Some visits simply run long — a complex new patient, a tangled medication reconciliation, a difficult conversation. Prolonged-service codes let you bill that extra time instead of donating it. The catch: Medicare and commercial payers use different codes and count the clock differently. Get both right and the time pays.
What these codes do
Prolonged office/outpatient E/M codes capture time beyond the top-level visit, billed in 15-minute increments. They attach to the highest-level codes (99205 new, 99215 established) when the visit is selected on total time, not medical decision-making.
99417 vs. G2212 — know your payer
This is the part that trips practices: Medicare requires G2212 and does not accept 99417. Many commercial payers (and some Medicaid programs) accept 99417. Billing 99417 to Medicare is an automatic denial. Map each payer before you submit.
Same idea, two codes. Send G2212 to Medicare and 99417 to the commercials — swapping them guarantees a denial.
The time thresholds
The counting rules differ too. G2212 starts only after the maximum time of the primary code is met — for 99215, that's after 54 minutes — plus a full 15 minutes. 99417 starts after the minimum time threshold of the level-5 code plus 15 minutes. Either way, the midpoint rule does not apply — you must complete the full 15 minutes before you can bill a unit.
Documentation that holds up
Because these are time-based, your note must state the total time on the date of service (face-to-face and non-face-to-face by the reporting practitioner) and describe the medically necessary work. Vague "spent extra time" language won't survive an audit. Precise time capture is exactly what strong medical coding enforces — see our E/M coding guide for the time-vs-MDM basics.
Leaving long-visit time unbilled?
We'll review your prolonged-service capture — free.
The bottom line
Prolonged services turn long visits into billable time — if you use the right code per payer (G2212 for Medicare, 99417 for many commercials), start counting at the correct threshold, and document total time. Get those three right and the extra 15-minute blocks pay. Start with a free billing audit.
Sources
Frequently asked questions
Both bill prolonged office/outpatient E/M time in 15-minute increments, but Medicare requires G2212 and does not accept 99417. Many commercial and some Medicaid payers accept 99417. They also count the starting point differently.
G2212 starts only after the maximum time of the highest-level primary E/M code is met — for an established 99215 visit, that is after 54 minutes — plus a full 15 minutes. The midpoint rule does not apply; you need the full 15 minutes.
No. Prolonged office/outpatient codes attach to the highest-level visits (99205/99215) selected on time. You must first meet the full time of that level-5 code before prolonged time begins.
Document the total time spent on the date of service (with and without direct patient contact) and the medically necessary content of both the E/M and the prolonged service. Time is the basis of the claim, so it must be clear.
See where your practice is leaking revenue.
A free, no-obligation billing audit shows exactly what the 2026 changes mean for your bottom line.
