CPT code 99358: Prolonged E/M, without direct contact2026 Medicare rate & RVUs

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99358 covers

This CPT code identifies prolonged evaluation and management work performed without direct patient contact. It is distinct from prolonged time spent with the patient during an E/M encounter. Physicians and other qualified health professionals use it for extended E/M-related work connected to a patient's care. CPT 99359 is the companion add-on for additional qualifying non-face-to-face prolonged service time.

Medicare assigns 99358 status I, meaning the code is not valid for Medicare. Medicare uses a different code to report and pay for this service, so 99358 is not the Medicare reporting code. Its non-face-to-face service distinction separates 99358 from prolonged E/M codes for direct-contact services.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99358 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99358 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99358 rate is calculated

Each of 99358’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99358

99358 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

99358 compared with similar codes

How to choose

99359Prolonged serviceAdditional 30 minutes

99358 is the primary code in the non-face-to-face prolonged-service pairing; 99359 is the add-on for additional qualifying time.

99417Prolonged E/MOffice or outpatient

99417 is for prolonged office or outpatient E/M time involving direct patient contact; 99358 describes work without direct contact.

99215Office visitEstablished patient, high complexity

99215 reports an established-patient office E/M visit. 99358 describes prolonged E/M-related work without direct patient contact, not the visit itself.

Codes related to 99358

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates