99359 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Prolong serv w/o contact add.
99359 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $36.55 | $36.55 | $36.55 | $36.55 | $39.08 | $39.08 |
⚠️ This is a National Estimate
Your actual reimbursement depends on your specific Zip Code and GPCI adjustments (e.g., New York vs. Texas).
Code Description
Prolong serv w/o contact add
Reimbursement Summary
CPT code 99359 (Prolong serv w/o contact add) had a 2026 Medicare non-facility reimbursement rate of $39.08. This reflects a 6.92% change from the prior year. The code carries 1.17 total RVUs across work, practice expense, and malpractice components.
For 2026, the estimated National Average Medicare payment for 99359 is $39.08 in a non-facility (office) setting and $32.40 in a facility (hospital/outpatient) setting. Your actual reimbursement depends on locality adjustments.
This code’s RVU components (Work, Practice Expense, and Malpractice) combine to approximately 1.17 total RVUs in the office setting and 0.97 total RVUs in the facility setting.
Description: Prolong serv w/o contact add. For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
99359 Reimbursement Rate History
| Quarter | Q1 2025 | Q2 2025 | Q3 2025 | Q4 2025 | Q1 2026 | Q2 2026 |
|---|---|---|---|---|---|---|
| National Average Payment | $36.55 | $36.55 | $36.55 | $36.55 | $39.08 | $39.08 |
Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q2 | $39.08 | $32.40 | +6.92% | -7.24% |
| 2026 Q1 | $39.08 | $32.40 | +6.92% | -7.24% |
| 2025 Q4 | $36.55 | $34.93 | — | — |
| 2025 Q3 | $36.55 | $34.93 | — | — |
| 2025 Q2 | $36.55 | $34.93 | — | — |
| 2025 Q1 | $36.55 | $34.93 | — | — |
Commercial Payer Rates for 99359
Pro FeatureNational average reimbursement from major commercial payers based on CMS Transparency in Coverage machine-readable files.
| Modifier | Place of Service | Avg. Rate | vs Medicare | Percentile Range |
|---|---|---|---|---|
| NULL | Office (11) | $91.46 | -4.0% | $80 — $104 |
| NULL | Telehealth (02) | $88.20 | -7.4% | $76 — $102 |
| NULL | Facility (21) | $79.31 | -15.6% | $68 — $95 |
| NULL | Outpatient Hospital (22) | $84.92 | -10.2% | $71 — $99 |
| NULL | Home (12) | $96.14 | +1.0% | $84 — $113 |
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Source: CMS Transparency in Coverage machine-readable files (MRFs). Commercial rates reflect payer-published negotiated amounts and may not reflect individual contracted rates.
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Facility vs. Non-Facility (Office) Payment
Medicare often publishes two payment rates for the same code: a **non-facility** rate (typically used when the service is performed in a private office where the clinician bears more overhead) and a **facility** rate (typically used when performed in a hospital or facility where the facility bills separately for its costs).
Because the practice expense portion of RVUs differs by setting, the non-facility and facility payment amounts can be different. For locality-adjusted estimates in 2026, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Q2 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | 0.75 | 0.75 |
| Practice Expense (PE) | 0.37 | 0.17 |
| Malpractice (MP) | 0.05 | 0.05 |
| Total RVUs | 1.17 | 0.97 |
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for 99359?
The 2026 National Average Medicare reimbursement rate for 99359 (Physician Service) is $39.08. This rate is effective as of January 1, 2026.
What is the description for code 99359?
Prolong serv w/o contact add
Why do facility and non-facility payments differ for 99359?
For many physician services, Medicare publishes different practice-expense RVUs by setting. In general, non-facility rates apply when services are performed in a private office, while facility rates apply when performed in a hospital or facility where the facility bills separately.
How can I find my local Medicare rate for 99359?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is 99359 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.
