CPT 99358
Global XXXProlong service w/o contact
CPT 99358 Billing & Documentation Guide
CPT code 99358 (Prolong service w/o contact) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.8, a non-facility practice expense RVU of 0.84, and a malpractice RVU of 0.11, a total non-facility RVU of 2.75 and facility RVU of 2.3. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $93.78, though rates vary from $86.11 to $122.09 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99358, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99358 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Invalid for Medicare; not separately payable
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 99358 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99358
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.8 | 1.8 |
| Practice Expense RVU | 0.84 | 0.39 |
| Malpractice RVU | 0.11 | 0.11 |
| Total RVU | 2.75 | 2.3 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99358
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $97.47 | $79.68 | $93.86 - $109.16 | 29 |
| Florida | $95.43 | $80.34 | $92.47 - $98.62 | 3 |
| Georgia | $91.38 | $77.04 | $89.53 - $93.22 | 2 |
| Illinois | $94.46 | $79.94 | $91.48 - $97.17 | 4 |
| Michigan | $91.64 | $77.53 | $89.89 - $93.39 | 2 |
| North Carolina | $88.65 | $74.62 | $88.65 - $88.65 | 1 |
| New York | $99.27 | $82.5 | $89.36 - $104.15 | 5 |
| Ohio | $89.44 | $75.72 | $89.44 - $89.44 | 1 |
| Pennsylvania | $92.07 | $77.35 | $89.35 - $94.79 | 2 |
| Texas | $91.49 | $76.69 | $89.07 - $93.52 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99358
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99358 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0366T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0367T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0368T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99358
What does CPT code 99358 mean? +
CPT code 99358 represents: Prolong service w/o contact. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99358? +
The 2026 Medicare national average non-facility payment for CPT 99358 is $93.78. Rates range from $86.11 to $122.09 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99358? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99358? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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