$11.94
99415 reports the first-hour prolonged clinical staff service; 99416 reports qualifying additional prolonged staff time.
On this page
CMS RVU26D · Effective 2026-10-01
99415 Prolonged staff care Medicare reimbursement rates in Wisconsin
Reports the first-hour add-on for extended direct-contact clinical staff service during an office or outpatient E/M encounter under physician supervision. Compare 99415 office and facility rates across CMS payment localities in Wisconsin.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99415 in Wisconsin?
Wisconsin has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$21.86
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Prolonged services
About 99415: Prolonged clinical staff service
Reports the first-hour add-on for extended direct-contact clinical staff service during an office or outpatient E/M encounter under physician supervision.
99415 captures prolonged, direct-contact clinical staff work during an office or other outpatient evaluation and management encounter, beyond the time ordinarily associated with that visit. Clinical staff perform the service under physician supervision; the code does not represent extra time personally spent by the physician or other qualified health care professional. It applies when staff remain engaged with the patient during an extended outpatient encounter, rather than for administrative work or unattended waiting time.
Report 99415 with the related office or outpatient E/M primary service. Document the reason for the extension and the clinical staff’s direct-contact time to support the reported service. This is an add-on, paid within the primary service’s global period, not a standalone visit. CMS classifies it as technical-component-only; any separately covered interpretation is represented by its distinct code. Use 99416 for qualifying additional prolonged clinical staff time.
CMS billing rules for 99415
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
- Professional and technical components
- Technical-component-only code: a separate code covers interpretation.
Where the value comes from
- Work RVU0.00 · 0%
- Practice expense (office) RVU0.68 · 99%
- Malpractice RVU0.01 · 1%
5.6K
Medicare services in 2024 · #1804 by national volume
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.
99415 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
99417
No office rateProlng op e/m each 15 min
99415 is for direct-contact clinical staff time during an office or outpatient E/M encounter. 99417 is for prolonged time attributable to the E/M professional.
99418
No office rateProlng ip/obs e/m ea 15 min
99415 concerns prolonged clinical staff service in an office or outpatient E/M encounter; 99418 is the prolonged E/M service code for inpatient or observation care.
Compare 99415 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Wisconsin →
Office / nonfacility
$21.86
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99415 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
13,098
- Code
- 99415
- Physician work
- 0.00
- Practice expense
- 0.68
- Malpractice
- 0.01
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.00 | × 1.000 | 0.0000 |
| Practice expense | 0.68 | × 0.958 | 0.6514 |
| Malpractice | 0.01 | × 0.308 | 0.0031 |
| Total RVUs | 0.6545 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$21.86
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0 | 1 |
| Practice expense | 0.68 | 0.958 |
| Malpractice | 0.01 | 0.308 |
(0 × 1 + 0.68 × 0.958 + 0.01 × 0.308) × $33.4009 = $21.86
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
99415 billing questions
When should I choose 99415 instead of 99417?
Use 99415 for prolonged direct-contact time furnished by clinical staff during an office or outpatient E/M encounter. 99417 describes prolonged time attributable to the E/M professional, not the clinical staff service.
What primary service must accompany 99415?
Report it with the related office or outpatient E/M service as an add-on. CMS pays it within that primary service’s global period.
Can I report 99415 for staff documentation or waiting time?
The service is for prolonged direct patient contact by clinical staff under physician supervision. Administrative documentation or time when staff are not engaged directly with the patient does not establish that service.
How do I report additional prolonged staff time?
99415 represents the first-hour add-on. Report 99416 for qualifying additional prolonged clinical staff time, supported by documentation of the direct-contact service and its duration.
Does 99415 represent the interpretation component?
CMS classifies 99415 as technical-component-only. A separately covered interpretation is represented by its distinct code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,09599409,,Audit/dast over 30 min,N,+,1.30,0.65,,0.29,,0.07,2.02,1.66,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,09699411,,Preventive counseling group,N,+,0.15,0.45,,0.03,,0.01,0.61,0.19,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,09799412,,Preventive counseling group,N,+,0.25,0.49,,0.06,,0.02,0.76,0.33,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,09899415,,Prolng clin staff svc 1st hr,A,,0.00,0.68,,0.68,NA,0.01,0.69,0.69,3,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,09999416,,Prolng clin staff svc ea add,A,,0.00,0.37,,0.37,NA,0.01,0.38,0.38,3,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10099417,,Prolng op e/m each 15 min,I,+,0.61,0.31,,0.14,,0.04,0.96,0.79,9,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10199418,,Prolng ip/obs e/m ea 15 min,I,+,0.81,0.18,NA,0.18,,0.05,1.04,1.04,9,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,