CPT code 99416: Prolonged staff service2026 Medicare rate & RVUs in Guam
Report 99416 for additional prolonged clinical staff time furnished under physician or qualified health care professional supervision with a qualifying office or outpatient E/M service.
Medicare pays $14.24 for 99416 in the office in Guam (Hawaii, Guam). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
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.
99416 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $14.24 | Unavailable |
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.
How the rate is built · 99416
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.37
0.37 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.3800
Conversion factor
$33.4009
Medicare rate
$12.69
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99416
The CMS indicators that decide how 99416 is paid alongside other services.
CMS payment indicators · 99416
Prolonged staff service
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 3 | Technical component only. |
99416 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99415Prolonged staff care
- 99415 represents the initial prolonged clinical staff service. Use 99416 for additional prolonged staff time, not as a substitute for the initial code.
- 99417Prolng op e/m each 15 min
- 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.
- 99418Prolng ip/obs e/m ea 15 min
- 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.
99416 billing questions
When should 99416 be used instead of 99415?
99415 represents the initial prolonged clinical staff service; 99416 represents additional prolonged staff time. Report 99416 only after the initial service is supported and with the required primary code.
Can 99416 be billed by itself?
No. CMS identifies it as an add-on code that must be billed with a primary procedure, typically 99415 for the initial prolonged clinical staff service.
What time should the record support?
Document the additional clinical staff time spent on the encounter, the work performed, and the supervising physician or qualified health care professional. The documentation should support each unit reported.
Is 99416 a physician professional service?
CMS classifies 99416 as technical-component-only and indicates that interpretation is covered separately. The record for this code should establish the clinical staff service and its supervision.
How does 99416 differ from 99417?
99416 represents additional prolonged time furnished by clinical staff. 99417 represents prolonged office or outpatient E/M time furnished by the physician or other qualified health care professional.
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
Show the CMS file lines behind this rate
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