CPT 99359
Global ZZZProlong serv w/o contact add
CPT 99359 Billing & Documentation Guide
CPT code 99359 (Prolong serv w/o contact add) is classified under E/M with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.75, a non-facility practice expense RVU of 0.37, and a malpractice RVU of 0.05, a total non-facility RVU of 1.17 and facility RVU of 0.97. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $39.89, though rates vary from $36.53 to $51.66 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99359, 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 99359 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
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 99359 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 99359
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.75 | 0.75 |
| Practice Expense RVU | 0.37 | 0.17 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 1.17 | 0.97 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99359
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 | $41.48 | $33.57 | $39.92 - $46.52 | 29 |
| Florida | $40.7 | $34 | $39.38 - $42.14 | 3 |
| Georgia | $38.88 | $32.5 | $38.07 - $39.69 | 2 |
| Illinois | $40.27 | $33.82 | $38.94 - $41.48 | 4 |
| Michigan | $39 | $32.74 | $38.22 - $39.79 | 2 |
| North Carolina | $37.65 | $31.42 | $37.65 - $37.65 | 1 |
| New York | $42.3 | $34.84 | $37.97 - $44.45 | 5 |
| Ohio | $38.02 | $31.92 | $38.02 - $38.02 | 1 |
| Pennsylvania | $39.17 | $32.62 | $37.97 - $40.36 | 2 |
| Texas | $38.91 | $32.33 | $37.85 - $39.82 | 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 99359
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99359 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 99359
What does CPT code 99359 mean? +
CPT code 99359 represents: Prolong serv w/o contact add. It's in the E/M category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 99359? +
The 2026 Medicare national average non-facility payment for CPT 99359 is $39.89. Rates range from $36.53 to $51.66 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99359? +
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 99359? +
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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