CPT 99417: Prolonged Outpatient E/M, Each 15 Minutes
CPT 99417 is a prolonged services add-on for each additional 15 minutes of office or outpatient E/M beyond a level-5 visit (99205 or 99215). Commercial payers accept it; Medicare requires G2212 instead. In 2026 it pays about $32.06 non-facility (0.96 total RVUs times the $33.4009 conversion factor).
- Code type
- Prolonged E/M add-on (per 15 min)
- 2026 non-facility
- $32.06 (0.96 RVUs)
- 2026 facility
- $26.39 (0.79 RVUs)
- Medicare
- Uses G2212 instead of 99417
What is CPT 99417 used for?
CPT 99417 is a prolonged services add-on reporting each additional 15 minutes of physician or QHP time on an office or outpatient E/M visit that already reached the top level (99205 for new, 99215 for established) selected by total time. It captures the extra work when a complex visit runs well beyond the level-5 time range.
The code is time-based only: you may report it exclusively when the base visit is leveled by total time, never when the base code is chosen by MDM. It also may not be reported with any code below level 5, so a long 99204 or 99214 does not qualify for 99417; the visit must first reach 99205 or 99215 on time.
How much does 99417 pay in 2026?
Using the fee-schedule values, 99417 is about 0.96 non-facility RVUs and 0.79 facility RVUs per unit at the 2026 conversion factor of $33.4009:
| Setting | Total RVUs | 2026 value per unit |
|---|---|---|
| Non-facility | 0.96 | ~$32.06 |
| Facility | 0.79 | ~$26.39 |
Remember it is a commercial-payer code, so the actual allowed amount depends on the plan. Model a total visit including add-ons with the Medicare fee calculator.
What are the time thresholds and the Medicare split?
The single most-missed 99417 rule is that the trigger time and the payer differ from Medicare's G2212. Per CPT, 99417 begins once the visit passes the top of the level-5 time range:
| Base code | 99417 trigger (CPT, commercial) | Payer |
|---|---|---|
| 99205 | 75 minutes total | Commercial |
| 99215 | 55 minutes total | Commercial |
You must reach a full 15-minute increment before adding a unit; partial increments are not reported. So a 99215 visit that runs 62 minutes does not yet earn a 99417, but at 70 minutes it does.
Frequently asked questions
Bill 99417 only with a level-5 outpatient E/M (99205 or 99215) selected by total time, for each additional 15 minutes beyond the minimum required time of that code. Per CPT, that is 75 minutes total for 99205 and 55 minutes for 99215. You must reach a full 15-minute increment; do not report it for partial increments.
Under the Medicare fee schedule values, 99417 corresponds to about $32.06 non-facility (0.96 total RVUs times $33.4009) and $26.39 in a facility per unit. However, Medicare itself does not pay 99417; it requires G2212. Commercial payers that recognize 99417 set their own allowed amounts, often near the Medicare-derived value.
No. Medicare assigns 99417 an invalid status and created G2212 as its prolonged-services replacement for office and outpatient E/M. Send 99417 to commercial payers that recognize CPT prolonged services, and send G2212 to Medicare. Sending the wrong one to the wrong payer triggers denials.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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