CPT code 99358: Prolonged E/M, without direct contact2026 Medicare rate & RVUs in Pennsylvania
Reports prolonged evaluation and management work performed without direct patient contact, distinct from prolonged time during a face-to-face or other direct-contact E/M service.
CMS doesn’t publish an office rate for 99358 in Pennsylvania.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Pennsylvania
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Philadelphia, PA | Unavailable | Unavailable |
| Rest of Pennsylvania | Unavailable | Unavailable |
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.
How the rate is built · 99358
RVUs × geographic indexes × conversion factor
Work1.80
1.80 RVUs× 1.000 GPCI
Practice expense0.84
0.84 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
2.7500
Conversion factor
$33.4009
Medicare rate
$91.85
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99358
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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99358 isn’t priced in this setting.
99358 compared with similar codes
Compare codes · National
4 codes, side by side
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.
99358 billing questions
What service does 99358 represent?
It represents prolonged E/M-related work performed without direct patient contact.
How does 99358 differ from 99359?
99358 is the primary code in this non-face-to-face prolonged-service pairing. 99359 is the add-on for additional qualifying service time.
Does 99358 report prolonged time with the patient?
No. It describes prolonged work without direct patient contact, rather than prolonged time during a direct-contact E/M service.
Can 99358 be reported to Medicare?
No. Medicare assigns it status I and uses a different code to report and pay for this service.
Is 99358 the E/M visit itself?
No. It represents prolonged E/M-related work without direct patient contact, not the patient encounter.
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
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