CPT code 99416: Prolonged staff service, each additional time unit2026 Medicare rate & RVUs

Medicare pays $12.69 for 99416 nationally in the office. Local office rates run $10.79–$18.00.

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

What 99416 covers

99416 represents additional time spent by clinical staff extending an office or outpatient evaluation and management service. It is used after the initial prolonged clinical staff service represented by 99415, when staff continue care under a physician’s or other qualified health care professional’s supervision. The work may occur in an office or outpatient setting; the claim must connect the staff time to the qualifying E/M encounter rather than to unrelated administrative work.

Report 99416 only with its required primary service, including 99415 for the initial prolonged staff service. Document the staff members involved, the supervised clinical work, and the additional time attributable to the encounter so the units billed are supported. CMS classifies this code as technical-component-only, with interpretation covered by a separate code. Payment is made within the primary procedure’s global period, so the add-on is not billed as a standalone service.

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 99416 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

99416 rates by state

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

How the 99416 rate is calculated

Each of 99416’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 99416

The CMS indicators that decide how 99416 is paid alongside other services.

99416 compared with similar codes

How to choose

99415Prolonged staff careFirst hour, outpatient E/M

99415 represents the initial prolonged clinical staff service. Use 99416 for additional prolonged staff time, not as a substitute for the initial code.

99417Prolonged E/MOffice or outpatient

99417 represents prolonged office or outpatient E/M time furnished by the physician or other qualified health care professional; 99416 represents additional time furnished by clinical staff.

99418Prolonged E/MInpatient or observation

99418 applies to prolonged inpatient or observation E/M time. 99416 is for additional prolonged clinical staff service associated with an office or outpatient E/M encounter.

Codes related to 99416

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