CPT code 99417: Prolonged E/M, office or outpatient2026 Medicare rate & RVUs in Illinois
An add-on for each 15-minute increment of prolonged physician or qualified health professional time beyond a qualifying office or other outpatient E/M service.
CMS doesn’t publish an office rate for 99417 in Illinois.
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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On this page 9 sections
What 99417 covers
CPT 99417 represents additional physician or qualified health professional time spent on a qualifying office or other outpatient evaluation and management service. It is an add-on to the primary E/M service, not a stand-alone visit code. The clinician’s prolonged work is associated with the outpatient encounter; this code is distinct from prolonged services provided by clinical staff and from prolonged inpatient or observation E/M services.
Each unit represents a 15-minute increment. The record should support the qualifying outpatient E/M service and the additional clinician time reported. Medicare assigns 99417 status I under the physician fee schedule: Medicare does not accept this code for reporting and payment. For Medicare prolonged office or outpatient E/M reporting, use G2212 instead.
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 99417 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | Unavailable |
| East St. Louis, IL | Unavailable | Unavailable |
| Rest of Illinois | Unavailable | Unavailable |
| Suburban Chicago, IL | Unavailable | Unavailable |
How the 99417 rate is calculated
Each of 99417’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 · 99417
RVUs × geographic indexes × conversion factor
Work0.61
0.61 RVUs× 1.000 GPCI
Practice expense0.31
0.31 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
0.9600
Conversion factor
$33.4009
Medicare rate
$32.06
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99417
The CMS indicators that decide how 99417 is paid alongside other services.
CMS payment indicators · 99417
Prolonged E/M, office or outpatient
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 9 | The concept doesn’t apply. |
| Bilateral (modifier 50) | 9 | The concept doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 9 | The concept doesn’t apply. |
| Co-surgeons (62) | 9 | The concept doesn’t apply. |
| Team surgery (66) | 9 | The concept doesn’t apply. |
| Professional/technical | 9 | The concept doesn’t apply. |
99417 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- G2212Prolonged office visitMedicare add-on, each 15 minutes
- 99417 is the CPT code for prolonged office or outpatient E/M time, but Medicare does not accept it. Medicare uses G2212 for this reporting purpose.
- 99418Prolonged E/MInpatient or observation
- 99418 applies to prolonged inpatient or observation E/M services; 99417 is for office or other outpatient E/M services.
- 99415Prolonged staff careFirst hour, outpatient E/M
- 99415 reports prolonged clinical staff services, not additional time personally spent by the physician or qualified health professional.
- 99416Prolonged staff serviceEach additional time unit
- 99416 is an additional prolonged clinical staff service code; 99417 represents prolonged physician or qualified health professional time.
99417 billing questions
Can 99417 be submitted to Medicare?
No. Medicare marks 99417 as status I and uses G2212 for prolonged office or outpatient E/M reporting.
What service is reported with 99417?
It reports additional physician or qualified health professional time associated with a qualifying office or other outpatient E/M service. It is an add-on, not a separate visit.
How much time does one unit represent?
One unit represents a 15-minute increment of prolonged clinician time.
How does 99417 differ from 99418?
99417 is for prolonged office or other outpatient E/M time. 99418 is the corresponding prolonged-service code for inpatient or observation E/M.
How does 99417 differ from 99415 and 99416?
99417 represents prolonged time spent by the physician or qualified health professional. 99415 and 99416 describe prolonged clinical staff services.
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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