CMS Time Table for Use with Prolonged Services Without Direct Face-to-Face Contact cpt_code Pre_Evaluation_ Time Pre_Positioning_t ime Pre_Service_Scrub_ Dress_Wait_tim Median_Intra_Se rvice_Time Immediate_post_Se rvice_time Total_time 00102 0 0 0 0 0 125.0 00103 0 0 0 0 0 131.6 00104 0 0 0 0 0 46.3 00120 0 0 0 0 0 150.4 00124 0 0 0 0 0 83.6 00126 0 0 0 0 0 72.8 00140 0 0 0 0 0 112.9 00142 15 0 0 38 10 63.0 00144 0 0 0 0 0 142.2 00145 0 0 0 0 0 161.4 00147 0 0 0 0 0 108.8 00148 0 0 0 0 0 116.4 00160 0 0 0 0 0 132.3 00162 0 0 0 0 0 162.8 00164 0 0 0 0 0 115.5 00170 0 0 0 0 0 117.1 00172 0 0 0 0 0 162.4 00174 0 0 0 0 0 110.5 00176 0 0 0 0 0 360.2 00190 0 0 0 0 0 169.3 00192 0 0 0 0 0 298.3 00210 0 0 0 0 0 267.5 00211 20 0 15 120 20 175.0 00212 0 0 0 0 0 139.7 00214 0 0 0 0 0 154.7
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
00102 0 0 0 0 0 125.0
00103 0 0 0 0 0 131.6
00104 0 0 0 0 0 46.3
00120 0 0 0 0 0 150.4
00124 0 0 0 0 0 83.6
00126 0 0 0 0 0 72.8
00140 0 0 0 0 0 112.9
00142 15 0 0 38 10 63.0
00144 0 0 0 0 0 142.2
00145 0 0 0 0 0 161.4
00147 0 0 0 0 0 108.8
00148 0 0 0 0 0 116.4
00160 0 0 0 0 0 132.3
00162 0 0 0 0 0 162.8
00164 0 0 0 0 0 115.5
00170 0 0 0 0 0 117.1
00172 0 0 0 0 0 162.4
00174 0 0 0 0 0 110.5
00176 0 0 0 0 0 360.2
00190 0 0 0 0 0 169.3
00192 0 0 0 0 0 298.3
00210 0 0 0 0 0 267.5
00211 20 0 15 120 20 175.0
00212 0 0 0 0 0 139.7
00214 0 0 0 0 0 154.7
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
00215 0 0 0 0 0 261.6
00216 0 0 0 0 0 388.1
00218 0 0 0 0 0 274.5
00220 0 0 0 0 0 171.6
00222 0 0 0 0 0 119.9
00300 0 0 0 0 0 119.3
00320 0 0 0 0 0 128.8
00322 0 0 0 0 0 130.6
00326 0 0 0 0 0 100.0
00350 0 0 0 0 0 210.9
00352 0 0 0 0 0 101.0
00400 0 0 0 0 0 98.8
00402 0 0 0 0 0 203.7
00404 0 0 0 0 0 155.7
00406 0 0 0 0 0 184.9
00410 0 0 0 0 0 52.8
00450 0 0 0 0 0 134.1
00454 0 0 0 0 0 107.3
00470 0 0 0 0 0 155.7
00472 0 0 0 0 0 206.6
00474 0 0 0 0 0 235.6
00500 0 0 0 0 0 358.9
00520 20 0 0 90 15 125.0
00522 0 0 0 0 0 134.5
00524 0 0 0 0 0 98.6
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
00528 30 0 0 80 15 125.0
00529 0 0 0 0 0 160.0
00530 0 0 0 0 0 126.6
00532 0 0 0 0 0 99.6
00534 0 0 0 0 0 168.4
00537 15 0 0 120 15 150.0
00539 0 0 0 0 0 300.0
00540 30 0 0 150 25 205.0
00541 0 0 0 0 0 202.5
00542 0 0 0 0 0 252.4
00546 0 0 0 0 0 293.9
00548 0 0 0 0 0 248.9
00550 12.5 0 0 90 20 122.5
00560 0 0 0 0 0 208.7
00561 45 0 0 300 30 375.0
00562 30 0 30 270 30 360.0
00563 60 0 0 300 30 390.0
00566 20 0 0 180 27.5 227.5
00567 30 0 30 247.5 30 337.5
00580 0 0 0 0 0 492.8
00600 0 0 0 0 0 257.2
00604 0 0 0 0 0 248.6
00620 0 0 0 0 0 235.0
00625 30 0 0 240 30 300.0
00626 40 0 0 300 30 370.0
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
00630 0 0 0 0 0 196.1
00632 0 0 0 0 0 156.3
00635 15 0 0 20 15 50.0
00640 0 0 0 0 0 52.5
00670 0 0 0 0 0 380.8
00700 0 0 0 0 0 109.4
00702 0 0 0 0 0 132.9
00730 0 0 0 0 0 126.5
00740 83.0
00750 0 0 0 0 0 125.0
00752 0 0 0 0 0 143.5
00754 0 0 0 0 0 138.4
00756 0 0 0 0 0 224.6
00770 0 0 0 0 0 326.6
00790 0 0 0 0 0 178.6
00792 0 0 0 0 0 354.2
00794 0 0 0 0 0 417.8
00796 0 0 0 0 0 639.8
00797 30 0 0 185 30 245.0
00800 0 0 0 0 0 110.0
00802 0 0 0 0 0 211.2
00810 51.0
00820 0 0 0 0 0 122.8
00830 0 0 0 0 0 123.6
00832 0 0 0 0 0 146.1
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
00834 0 0 0 0 0 95.0
00836 0 0 0 0 0 110.0
00840 0 0 0 0 0 184.7
00842 0 0 0 0 0 139.1
00844 0 0 0 0 0 256.0
00846 0 0 0 0 0 236.9
00848 0 0 0 0 0 347.0
00851 15 0 0 60 10 85.0
00860 0 0 0 0 0 173.4
00862 0 0 0 0 0 237.4
00864 0 0 0 0 0 418.8
00865 20 0 0 180 25 225.0
00866 0 0 0 0 0 271.8
00868 0 0 0 0 0 320.9
00870 0 0 0 0 0 123.8
00872 0 0 0 0 0 131.6
00873 0 0 0 0 0 127.1
00880 0 0 0 0 0 339.5
00882 0 0 0 0 0 151.6
00902 0 0 0 0 0 88.1
00904 0 0 0 0 0 250.7
00906 0 0 0 0 0 130.6
00908 0 0 0 0 0 231.8
00910 0 0 0 0 0 87.0
00912 0 0 0 0 0 101.7
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
00914 0 0 0 0 0 125.6
00916 0 0 0 0 0 112.3
00918 0 0 0 0 0 117.2
00920 0 0 0 0 0 105.5
00921 15 0 0 30 10 55.0
00922 0 0 0 0 0 134.8
00924 0 0 0 0 0 112.6
00926 0 0 0 0 0 108.2
00928 0 0 0 0 0 138.7
00930 0 0 0 0 0 111.5
00932 0 0 0 0 0 153.5
00934 0 0 0 0 0 233.8
00936 0 0 0 0 0 215.5
00938 0 0 0 0 0 171.7
00940 0 0 0 0 0 82.3
00942 0 0 0 0 0 151.4
00944 0 0 0 0 0 192.8
00948 0 0 0 0 0 86.9
00950 0 0 0 0 0 115.4
00952 0 0 0 0 0 83.6
01112 0 0 0 0 0 90.0
01120 0 0 0 0 0 155.1
01130 0 0 0 0 0 110.2
01140 0 0 0 0 0 276.8
01150 0 0 0 0 0 287.6
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
01160 0 0 0 0 0 94.2
01170 0 0 0 0 0 197.5
01173 0 35 0 300 30 365.0
01180 0 0 0 0 0 131.6
01190 0 0 0 0 0 116.6
01200 0 0 0 0 0 82.1
01202 0 0 0 0 0 150.1
01210 0 0 0 0 0 168.7
01212 0 0 0 0 0 214.9
01214 12.5 0 0 120 20 152.5
01215 15 0 0 150 15 180.0
01220 0 0 0 0 0 118.8
01230 0 0 0 0 0 158.6
01232 0 0 0 0 0 135.8
01234 0 0 0 0 0 190.7
01250 0 0 0 0 0 119.4
01260 0 0 0 0 0 154.7
01270 0 0 0 0 0 267.5
01272 0 0 0 0 0 143.3
01274 0 0 0 0 0 172.5
01320 0 0 0 0 0 131.7
01340 0 0 0 0 0 125.8
01360 0 0 0 0 0 191.5
01380 0 0 0 0 0 72.6
01382 0 0 0 0 0 72.5
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
01390 0 0 0 0 0 119.9
01392 0 0 0 0 0 169.7
01400 0 0 0 0 0 150.0
01402 0 0 0 0 0 208.6
01404 0 0 0 0 0 140.3
01420 0 0 0 0 0 147.1
01430 0 0 0 0 0 230.9
01432 0 0 0 0 0 163.8
01440 0 0 0 0 0 227.4
01442 0 0 0 0 0 226.7
01444 0 0 0 0 0 304.9
01462 0 0 0 0 0 110.0
01464 0 0 0 0 0 102.5
01470 0 0 0 0 0 110.1
01472 0 0 0 0 0 152.7
01474 0 0 0 0 0 182.5
01480 0 0 0 0 0 132.0
01482 0 0 0 0 0 136.4
01484 0 0 0 0 0 159.8
01486 0 0 0 0 0 227.9
01490 0 0 0 0 0 105.0
01500 0 0 0 0 0 267.6
01502 0 0 0 0 0 182.5
01520 0 0 0 0 0 158.2
01522 0 0 0 0 0 150.7
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
01610 0 0 0 0 0 150.7
01620 0 0 0 0 0 85.4
01622 0 0 0 0 0 105.0
01630 0 0 0 0 0 125.0
01634 0 0 0 0 0 203.3
01636 0 0 0 0 0 322.0
01638 0 0 0 0 0 240.5
01650 0 0 0 0 0 177.6
01652 0 0 0 0 0 200.1
01654 0 0 0 0 0 257.1
01656 0 0 0 0 0 308.3
01670 0 0 0 0 0 122.6
01680 0 0 0 0 0 120.3
01682 0 0 0 0 0 117.8
01710 0 0 0 0 0 112.8
01712 0 0 0 0 0 210.7
01714 0 0 0 0 0 154.0
01716 0 0 0 0 0 164.9
01730 0 0 0 0 0 110.5
01732 0 0 0 0 0 110.0
01740 0 0 0 0 0 125.0
01742 0 0 0 0 0 176.2
01744 0 0 0 0 0 214.2
01756 0 0 0 0 0 179.0
01758 0 0 0 0 0 134.8
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
01760 0 0 0 0 0 283.6
01770 0 0 0 0 0 174.7
01772 0 0 0 0 0 137.7
01780 0 0 0 0 0 113.6
01782 0 0 0 0 0 132.4
01810 0 0 0 0 0 101.6
01820 0 0 0 0 0 101.3
01829 0 0 0 0 0 85.0
01830 0 0 0 0 0 124.0
01832 0 0 0 0 0 169.3
01840 0 0 0 0 0 158.6
01842 0 0 0 0 0 132.9
01844 0 0 0 0 0 156.3
01850 0 0 0 0 0 96.3
01852 0 0 0 0 0 95.2
01860 0 0 0 0 0 88.6
01916 19 0 0 46.5 15 80.5
01920 0 0 0 0 0 117.6
01922 0 0 0 0 0 126.1
01924 20 0 0 90 15 125.0
01925 25 0 0 90 20 135.0
01926 30 0 0 120 20 170.0
01930 18 0 0 60 15 93.0
01931 20 0 0 105 20 145.0
01932 27.5 0 0 90 20 137.5
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
01933 25 0 0 77.5 15 117.5
01935 20 0 0 55 15 90.0
01936 30 0 0 70 15 115.0
01951 15 0 0 60 20 95.0
01952 15 0 0 90 25 130.0
01953 20 0 0 120 30 170.0
01958 0 0 0 0 0 85.0
01960 10 0 0 45 15 70.0
01961 15 0 0 75 11 101.0
01962 15 0 0 75 15 105.0
01963 10.5 0 0 120 20 150.5
01965 15 0 0 30 10 55.0
01966 0 0 0 0 0 60.0
01967 15 0 0 97.5 10 122.5
01968 10 0 0 75 10 95.0
01969 15 0 0 150 20 185.0
01990 0 0 0 0 0 29.8
01991 0 0 0 0 0 55.0
01992 0 0 0 0 0 55.0
01996 0 0 0 0 0 22.8
01999 0 0 0 0 0 17.6
10021 21 0 0 17 10 48
10022 11 0 0 20 10 41
10030 16 5 5 30 20 76
10035 13 2 5 15 10 45
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
10036 14 14
10040 7 0 0 14 7 36
10060 8 3 5 15 10 57
10061 8 3 5 25 10 83
10080 8 0 0 15 8 47
10081 9 0 0 27 9 61
10120 8 1 5 15 3 48
10121 10 0 0 53 9 88
10140 17 3 5 15 10 66
10160 17 3 5 10 10 61
10180 8 0 0 20 8 52
11000 5 0 0 10 5 20
11001 0 0 0 10 0 10
11004 30 15 20 90 30 240
11005 30 15 15 120 30 265
11006 30 15 20 120 30 270
11008 0 0 0 60 0 60
11010 45 0 0 50 30 125
11011 45 0 0 60 45 150
11012 60 0 0 90 60 210
11042 9 1 1 15 10 36
11043 33 3 5 30 15 86
11044 33 3 15 45 20 116
11045 0 0 0 15 0 15
11046 0 0 0 20 1 21
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
11047 0 0 0 30 1 31
11055 5 2 0 4 2 13
11056 5 2 0 10 2 19
11057 5 2 0 15 2 24
11100 5 0 0 12 5 22
11101 0 0 0 10 0 10
11200 4 0 0 7 2 29
11201 0 0 0 5 0 5
11300 0 1 5 10 5 21
11301 0 1 5 15 5 26
11302 0 1 5 20 5 31
11303 0 1 5 22 5 33
11305 0 1 5 14 5 25
11306 0 1 5 18 5 29
11307 0 1 5 21 5 32
11308 0 1 5 26 5 37
11310 0 1 5 20 5 31
11311 0 1 5 25 5 36
11312 0 1 5 30 5 41
11313 0 1 5 35 5 46
11400 5 0 0 10 5 36
11401 10 0 0 20 5 51
11402 10 0 0 25 5 56
11403 10 5 5 30 10 76
11404 10 5 5 40 10 86
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
11406 10 5 5 60 10 113
11420 5 0 0 10 5 36
11421 10 0 0 20 5 51
11422 10 0 0 25 5 56
11423 10 5 5 30 10 76
11424 10 5 5 40 10 86
11426 10 5 5 60 10 113
11440 5 0 0 10 5 36
11441 10 0 0 20 5 51
11442 10 0 0 25 5 56
11443 10 5 5 30 10 76
11444 10 5 5 40 10 86
11446 10 5 5 60 10 113
11450 8 0 0 43 8 93.5
11451 7 0 0 51 7 99.5
11462 8 0 0 48 8 98.5
11463 7 0 0 61 7 109.5
11470 8 0 0 50 8 100.5
11471 8 0 0 57 8 107.5
11600 10 0 0 10 5 48
11601 15 0 0 20 5 63
11602 15 0 0 25 5 68
11603 20 5 5 30 10 93
11604 20 5 5 40 10 103
11606 20 5 5 90 10 153
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
11620 10 0 0 10 5 48
11621 15 0 0 20 5 63
11622 15 0 0 25 5 68
11623 20 5 5 30 10 93
11624 20 5 5 40 10 103
11626 20 5 5 60 10 123
11640 10 0 0 10 5 48
11641 15 0 0 20 5 63
11642 15 0 0 25 5 68
11643 20 5 5 30 10 93
11644 20 5 5 45 10 108
11646 20 5 5 65 10 128
11719 4 1 0 5 2 12
11720 5 2 0 5 2 14
11721 5 2 0 10 2 19
11730 10 3 5 10 5 33
11732 0 1 1 8 1 11
11740 4 0 0 16 4 24
11750 17 3 5 15 7 63
11752 15 0 0 25 15 124
11755 15 0 0 25 15 55
11760 7 0 0 33 7 63
11762 10 0 15 60 10 111
11765 17 1 5 15 5 59
11770 9 0 0 37 9 71
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
11771 21 0 15 58 18 236
11772 27 0 25 63 22 269
11900 5 0 0 8 2 15
11901 5 0 0 13 4 22
11920 20 0 0 30 15 65
11921 20 0 0 45 15 80
11922 0 0 0 60 0 60
11950 10 0 0 15 10 35
11951 15 0 0 30 10 55
11952 20 0 0 40 15 75
11954 20 0 0 53 15 88
11960 60 0 0 78 30 444
11970 28 0 15 78 22 231
11971 53 0 0 90 30 303
11976 3 0 0 38 3 44
11980 7 2 1 12 5 27
11981 0 0 0 0 0 39
11982 0 0 0 0 0 44
11983 0 0 0 0 0 69
12001 5 1 1 10 5 22
12002 5 1 1 15 5 27
12004 5 1 1 17 5 29
12005 8 2 1 25 5 41
12006 8 2 1 30 6 47
12007 8 2 1 35 8 54
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
12011 5 1 1 12 5 24
12013 5 1 1 15 5 27
12014 5 1 1 20 5 32
12015 5 1 1 25 5 37
12016 8 2 1 30 6 47
12017 8 2 1 40 8 59
12018 8 2 1 45 8 64
12020 9 0 0 31 8 64
12021 7 0 0 21 7 51
12031 7 1 5 20 7 56
12032 8 1 5 30 8 68
12034 8 1 5 45 10 85
12035 11 3 5 60 10 124
12036 13 3 5 70 12 138
12037 13 3 5 90 12 158
12041 8 1 5 21 8 59
12042 8 1 5 30 9 69
12044 8 1 5 45 10 85
12045 9 3 5 60 11 146
12046 9 3 5 80 9 164
12047 9 3 5 100 10 185
12051 8 1 5 20 8 58
12052 8 1 5 30 10 70
12053 8 1 5 40 10 80
12054 12 3 5 50 10 96
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
12055 13 3 5 60 13 152
12056 13 3 5 70 13 162
12057 13 3 5 90 15 184
13100 5 1 5 32 10 69
13101 5 1 5 45 10 82
13102 0 0 0 30 0 30
13120 7 1 5 35 10 74
13121 8 1 5 45 10 85
13122 0 0 0 30 0 30
13131 10 1 5 45 15 92
13132 10 1 5 50 15 97
13133 0 0 0 35 0 35
13151 10 1 8 45 15 95
13152 10 1 8 50 15 100
13153 0 0 0 45 0 45
13160 37 0 25 95 26 363
14000 25 0 0 64 22 191.5
14001 34 0 15 105 26 291
14020 29 0 0 78 24 223
14021 37 0 15 116 28 288
14040 15 10 5 90 25 223
14041 34 0 15 135 27 303
14060 15 10 5 60 15 183
14061 38 0 15 157 28 341.5
14301 33 10 15 100 25 287
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
14302 0 0 0 40 0 40
14350 32 0 25 113 26 318.5
15002 45 15 15 20 20 115
15003 0 0 0 15 1 16
15004 45 15 15 45 30 150
15005 0 0 0 20 1 21
15040 15 10 10 15 10 60
15050 21 0 15 43 19 190
15100 45 10 10 60 20 281
15101 0 0 0 29 0 29
15110 20 20 10 28 20 306
15111 0 0 0 25 0 25
15115 20 20 15 35 20 356
15116 0 0 0 35 0 35
15120 40 12 20 75 30 258
15121 0 0 0 30 0 30
15130 10 10 10 25 18 215
15131 0 0 0 18 0 18
15135 13 12 10 28 18 223
15136 0 0 0 15 0 15
15150 30 25 15 20 30 326
15151 0 0 0 20 0 20
15152 0 0 0 20 0 20
15155 30 30 15 25 30 336
15156 0 0 0 20 0 20
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
15157 0 0 0 30 0 30
15200 30 0 25 90 24 287.5
15201 0 0 0 30 0 30
15220 27 0 15 90 27 250
15221 0 0 0 24 0 24
15240 45 10 10 60 20 288
15241 0 0 0 45 0 45
15260 17 1 10 100 30 273
15261 0 0 0 40 0 40
15271 13 1 6 15 10 45
15272 0 0 0 10 0 10
15273 40 10 10 20 20 100
15274 0 0 0 10 0 10
15275 13 1 6 15 10 45
15276 0 0 0 10 0 10
15277 40 15 10 25 20 110
15278 0 0 0 14 0 14
15570 40 13 20 100 30 363
15572 40 13 20 90 30 297
15574 40 10 20 110 30 314
15576 40 10 20 90 30 271
15600 24 0 25 52 27 179
15610 24 0 25 52 27 179
15620 24 0 15 52 27 175.5
15630 27 0 15 56 26 181.5
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
15650 28 0 25 70 22 221.5
15731 50 10 15 120 30 369
15732 40 12 20 150 60 403
15734 30 15 15 163 30 524
15736 60 0 0 150 30 400
15738 60 0 0 150 30 460
15740 39 0 15 118 32 365.5
15750 38 0 25 146 30 400.5
15756 90 0 0 360 60 809
15757 90 0 0 360 60 829
15758 90 0 0 360 60 809
15760 33 0 15 105 26 278.5
15770 28 0 25 104 23 302.5
15775 30 0 0 60 20 110
15776 30 0 0 90 20 140
15777 5 0 0 45 0 50
15780 30 0 0 71 21 244.5
15781 26 0 0 43 19 144
15782 21 0 0 44 18 123
15783 21 0 0 38 18 117
15786 10 0 0 17 10 53
15787 0 0 0 8 0 8
15788 0 0 0 40 0 40
15789 0 0 0 57 0 57
15792 0 0 0 36 0 36
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
15793 27 0 0 55 21 175
15819 37 0 15 125 28 316
15820 27 0 15 36 20 178.5
15821 28 0 15 46 22 191.5
15822 26 0 15 33 21 151
15823 10 1 5 45 10 161
15824 0 0 0 0 0 0
15825 0 0 0 0 0 0
15826 0 0 0 0 0 0
15828 0 0 0 0 0 0
15829 0 0 0 0 0 0
15830 50 15 15 120 30 429
15832 39 0 15 150 30 364
15833 41 0 15 126 30 342
15834 37 0 15 131 29 352
15835 38 0 15 121 30 344
15836 38 0 15 113 25 302
15837 33 0 15 85 26 239.5
15838 32 0 15 54 24 205.5
15839 33 0 15 101 26 274.5
15840 38 0 25 159 30 443.5
15841 54 0 25 333 41 769
15842 67 0 25 462 52 963.5
15845 43 0 25 198 30 460.5
15847 0 0 0 0 0 0
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
15850 15 0 0 18 10 43
15851 11 0 0 18 11 40
15852 13 0 0 33 13 59
15860 12 0 0 23 12 47
15876 0 0 0 0 0 0
15877 0 0 0 0 0 0
15878 0 0 0 0 0 0
15879 0 0 0 0 0 0
15920 28 0 25 88 23 294
15922 32 0 25 113 26 354
15931 26 0 25 56 23 334
15933 31 0 25 84 27 403
15934 30 0 25 124 22 441
15935 37 0 25 139 31 524
15936 27 0 25 125 20 399
15937 29 0 25 160 22 466
15940 26 0 25 65 18 340
15941 31 0 25 88 28 418
15944 34 0 25 108 28 441
15945 35 0 25 120 29 473
15946 46 0 25 184 47 650
15950 26 0 25 55 24 282
15951 31 0 25 79 28 389
15952 34 0 25 107 28 430
15953 35 0 25 121 29 454
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
15956 40 0 25 169 32 568
15958 40 0 25 173 32 572
15999 0 0 0 0 0 0
16000 4 0 0 23 4 31
16020 5 0 0 15 3 23
16025 7 3 5 20 3 38
16030 15 5 10 35 13 78
16035 30 0 0 20 20 70
16036 0 0 0 20 0 20
17000 1 1 0 3 2 23
17003 0 0 0 1 0 1
17004 1 1 0 13 4 35
17106 7 0 0 30 10 86
17107 7 0 0 40 10 112
17108 7 0 0 60 10 148
17110 3 0 0 7 3 29
17111 3 0 0 10 2 31
17250 5 2 0 5 5 17
17260 7 0 2 16 5 46
17261 7 0 2 17 5 47
17262 7 0 2 20 5 50
17263 7 0 2 26 5 56
17264 7 0 2 34 5 64
17266 7 0 2 37 5 67
17270 7 0 2 15 5 45
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
17271 7 0 2 19 5 49
17272 7 0 2 22 5 52
17273 7 0 2 26 5 56
17274 7 0 2 32 5 62
17276 7 0 2 40 5 70
17280 7 0 2 15 5 45
17281 7 0 2 17 5 47
17282 7 0 2 25 5 55
17283 7 0 2 30 5 60
17284 7 0 2 36 5 66
17286 7 0 2 48 5 78
17311 14 1 5 110 8 138
17312 2 1 5 65 0 73
17313 14 1 5 100 8 128
17314 2 1 5 60 0 68
17315 0 0 0 30 0 30
17340 3 0 0 7 3 16.5
17360 4 0 0 13 4 29
17380 0 0 0 0 0 0
17999 0 0 0 0 0 0
19000 12 0 0 7 12 31
19001 0 0 0 7 0 7
19020 48 0 0 48 14 177
19030 7 0 0 21 7 35
19081 13 3 6 30 15 67
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
19082 0 1 4 25 0 30
19083 13 1 5 25 15 59
19084 0 1 4 20 0 25
19085 13 3 6 45 15 82
19086 0 1 4 38 0 43
19100 15 0 0 30 15 60
19101 35 0 15 32 18 116
19105 30 5 10 45 15 105
19110 21 0 15 42 18 144
19112 20 0 15 37 17 137
19120 32 0 0 45 20 136
19125 60 0 0 60 30 196
19126 0 0 0 60 0 60
19260 37 0 25 112 28 510.5
19271 43 0 25 189 35 669.5
19272 48 0 25 229 39 760
19281 13 1 6 30 15 65
19282 0 1 4 20 0 25
19283 13 3 6 20 15 57
19284 0 1 4 20 0 25
19285 13 1 6 15 15 50
19286 0 1 4 15 0 20
19287 13 3 6 37 15 74
19288 0 1 4 30 0 35
19296 30 10 15 30 15 119
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
19297 5 0 0 30 5 40
19298 25 15 15 60 30 164
19300 24 0 15 50 20 184
19301 30 10 15 60 20 216
19302 40 3 15 100 20 276
19303 30 15 15 90 20 314
19304 32 0 25 94 25 286
19305 44 0 25 137 26 463.5
19306 50 0 25 166 29 544.5
19307 37 0 25 104 31 441.5
19316 60 0 0 110 30 293
19318 60 0 0 150 30 321
19324 34 0 15 150 22 290
19325 60 0 0 90 30 244
19328 23 0 15 38 20 172.5
19330 29 0 15 62 24 218
19340 33 8 15 120 30 366
19342 39 0 15 115 28 319.5
19350 45 0 0 90 30 229
19355 29 0 15 70 23 206
19357 33 3 15 110 30 468
19361 35 20 15 240 30 552
19364 60 0 0 390 45 767
19366 60 0 0 243 30 462
19367 60 0 0 300 30 590
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
19368 60 0 0 420 90 830
19369 60 0 0 360 95 755
19370 33 0 15 82 23 252.5
19371 37 0 15 117 26 306
19380 36 0 15 89 26 277
19396 30 0 0 45 13 88
19499 0 0 0 0 0 0
20005 21 0 25 43 19 182
20100 45 0 0 90 60 296
20101 30 0 0 30 30 97
20102 30 0 0 30 30 106
20103 30 0 0 60 30 136
20150 60 0 0 120 30 337
20200 12 0 0 31 12 55
20205 16 0 15 33 15 79
20206 10 0 0 18 11 39
20220 14 0 0 22 13 49
20225 45 0 0 60 30 135
20240 33 10 15 30 30 118
20245 40 15 15 60 30 160
20250 27 5 25 100 17 248
20251 27 5 25 89 18 238
20500 11 0 0 18 11 56
20501 9 0 0 16 9 34
20520 12 0 0 25 12 65
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
20525 20 0 15 48 18 136
20526 6 0 0 5 5 16
20527 7 1 0 5 5 18
20550 5 1 5 5 5 21
20551 10 0 0 5 5 20
20552 5 1 5 5 5 21
20553 5 2 5 10 5 27
20555 30 5 15 70 30 150
20600 5 1 5 5 5 21
20604 5 2 5 10 5 27
20605 5 1 5 5 5 21
20606 5 2 5 10 5 27
20610 5 1 5 5 5 21
20611 5 2 5 10 5 27
20612 10 0 0 5 5 20
20615 23 0 0 32 17 88
20650 12 0 15 38 14 114
20660 20 0 10 30 30 90
20661 22 0 25 69 18 266
20662 26 0 25 91 21 285
20663 24 0 25 73 20 264
20664 90 0 0 60 30 405
20665 11 0 0 19 11 57
20670 9 0 0 23 9 57
20680 35 15 15 50 15 181
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
20690 30 15 15 60 20 300
20692 70 18 15 120 20 474
20693 20 0 25 49 18 208
20694 15 0 25 26 15 140
20696 33 15 15 180 30 468
20697 0 0 0 0 0 0
20802 90 0 0 600 36 1041
20805 60 0 0 600 37 1012
20808 60 0 0 720 37 1112
20816 60 0 0 360 150 809
20822 45 0 0 300 125 685
20824 60 0 0 360 125 784
20827 60 0 0 300 133 728
20838 75 0 0 520 135 1085
20900 33 3 15 30 15 96
20902 33 10 15 45 20 123
20910 25 0 15 81 23 227
20912 25 0 25 88 35 256
20920 21 0 25 31 22 195
20922 20 0 25 42 21 224
20924 19 0 25 34 20 194
20926 19 0 25 32 20 202
20930 0 0 0 0 0 0
20931 0 0 0 20 0 20
20936 0 0 0 0 0 0
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
20937 0 0 0 40 0 40
20938 0 0 0 45 0 45
20950 14 0 0 35 12 61
20955 100 0 0 480 170 1095
20956 90 0 0 400 60 894
20957 90 0 0 420 60 930
20962 40 25 25 260 30 380
20969 120 0 0 540 200 1216
20970 100 0 0 500 200 1156
20972 90 0 0 480 32 898
20973 120 0 0 540 200 1156
20974 0 0 0 24 0 24
20975 0 0 0 99 0 99
20979 0 0 0 24 0 24
20982 13 15 10 80 30 148
20983 30 15 5 115 25 190
20985 10 0 0 20 0 30
20999 0 0 0 0 0 0
21010 40 0 0 98 30 337
21011 22 6 0 30 10 107
21012 19 6 5 45 15 148
21013 33 8 15 45 15 174
21014 33 8 15 60 20 217
21015 40 8 20 75 30 277
21016 40 8 20 100 30 398
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
21025 60 10 15 90 30 283
21026 45 0 0 60 20 261
21029 40 0 0 60 15 196
21030 30 0 0 33 15 133
21031 25 0 0 30 15 93
21032 33 0 0 45 15 125
21034 60 0 0 120 25 365
21040 30 0 0 37 15 137
21044 60 0 0 90 22 325
21045 68 0 0 210 30 599
21046 75 0 0 120 30 400
21047 90 0 0 240 40 565
21048 75 0 0 120 30 400
21049 90 0 0 225 40 550
21050 58 0 0 120 30 377
21060 48 0 0 120 30 334
21070 45 0 0 90 30 246
21073 15 10 5 20 20 134
21076 0 0 0 0 0 338
21077 0 0 0 0 0 698
21079 0 0 0 0 0 498
21080 0 0 0 0 0 537
21081 0 0 0 0 0 505
21082 0 0 0 0 0 47
21083 0 0 0 0 0 446
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
21084 0 0 0 0 0 496
21085 0 0 0 0 0 248
21086 0 0 0 0 0 534
21087 0 0 0 0 0 533
21088 0 0 0 0 0 0
21089 0 0 0 0 0 0
21100 35 0 0 76 15 232
21110 30 0 0 100 15 239
21116 10 0 0 25 0 35
21120 27 0 0 55 46 184
21121 27 0 0 64 46 193
21122 27 0 0 88 49 247
21123 28 0 0 111 56 297
21125 60 0 0 90 45 297
21127 30 0 0 134 54 358
21137 30 0 0 120 60 310
21138 53 0 0 180 60 400
21139 60 0 0 210 68 458
21141 35 0 0 181 30 474
21142 35 0 0 192 30 485
21143 35 0 0 204 30 497
21145 43 0 0 202 64 515
21146 46 0 0 227 67 567.5
21147 46 0 0 252 67 707.5
21150 90 0 0 240 73 623
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
21151 90 0 0 280 105 715
21154 90 0 0 360 90 857
21155 90 0 0 420 120 972
21159 120 0 0 420 84 986
21160 120 0 0 480 84 1121
21172 60 0 0 240 69 641
21175 75 0 0 300 69 731
21179 60 0 0 215 75 590
21180 60 0 0 280 90 670
21181 60 0 0 165 60 396
21182 90 0 0 360 64 801
21183 90 0 0 390 84 891
21184 90 0 0 480 99 996
21188 90 0 0 240 90 570
21193 48 0 0 95 60 386
21194 55 0 0 158 65 482.5
21195 50 0 0 79 61 384.5
21196 52 0 0 105 60 411.5
21198 47 0 0 96 55 359.5
21199 30 0 0 90 30 283
21206 45 0 0 108 57 361.5
21208 35 0 0 112 20 320
21209 35 0 0 79 20 270
21210 23 0 0 124 30 318
21215 23 0 0 140 30 334
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
21230 30 0 0 189 30 342
21235 35 0 0 97 20 265
21240 48 0 25 115 41 425
21242 35 0 0 115 20 402
21243 103 0 0 240 60 751
21244 35 0 0 80 20 387
21245 25 0 0 150 25 376
21246 30 0 0 200 30 369
21247 35 0 0 254 20 544
21248 23 0 0 76 32 223
21249 25 0 0 145 33 295
21255 30 0 0 167 25 457
21256 75 0 0 191 20 444
21260 30 0 0 170 30 426
21261 30 0 0 300 30 674
21263 30 0 0 265 30 639
21267 30 0 0 180 30 476
21268 30 0 0 240 30 614
21270 45 0 0 232 30 362
21275 60 0 0 157 30 360
21280 60 0 0 74 15 251
21282 60 0 0 55 15 209
21295 15 0 0 42 5 101
21296 30 0 0 71 5 219
21299 0 0 0 0 0 0
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
21310 20 0 0 15 10 45
21315 25 0 0 30 21 99
21320 22 0 0 25 23 78
21325 30 0 0 64 30 217
21330 30 0 0 98 30 251
21335 30 0 0 140 30 293
21336 30 0 0 90 22 243
21337 25 0 0 45 22 154
21338 30 0 0 138 30 291
21339 30 0 0 162 30 315
21340 60 0 0 141 30 347
21343 30 0 0 150 30 389
21344 30 0 0 225 30 519
21345 35 0 0 105 20 312
21346 60 0 0 126 30 352
21347 60 0 0 167 30 393
21348 60 0 0 226 30 452
21355 30 0 0 60 24 176
21356 30 0 0 70 23 185
21360 30 0 0 135 30 273
21365 27 5 25 123 59 432
21366 45 0 0 241 45 467
21385 30 0 0 171 30 324
21386 30 0 0 167 30 320
21387 30 0 0 182 30 335
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
21390 60 0 0 147 20 346
21395 30 15 15 120 30 347
21400 30 0 0 25 15 102
21401 30 0 0 51 30 204
21406 30 0 0 131 30 284
21407 30 0 0 163 30 316
21408 30 0 0 232 30 385
21421 35 0 0 71 20 256
21422 30 0 0 166 30 319
21423 30 0 0 190 30 359
21431 35 0 0 109 15 295
21432 45 0 0 150 45 330
21433 60 0 0 316 60 592
21435 120 0 0 450 45 1001
21436 30 0 0 300 40 644
21440 18 0 0 56 10 162
21445 35 0 0 77 10 252
21450 18 0 0 51 15 162
21451 30 0 0 94 15 252
21452 15 0 0 39 5 133
21453 35 0 0 80 10 261
21454 30 0 0 91 15 288
21461 30 0 0 103 10 318
21462 30 0 0 127 10 342
21465 30 0 0 158 10 373
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
21470 30 0 25 129 59 469
21480 25 0 0 25 21 71
21485 24 0 0 75 10 203
21490 35 0 0 177 20 368
21495 35 0 0 79 15 265
21497 35 0 0 81 10 239
21499 0 0 0 0 0 0
21501 18 0 25 40 18 176
21502 21 0 25 67 20 275
21510 24 0 25 73 23 295
21550 20 0 0 36 17 89
21552 33 3 15 60 25 194
21554 40 20 20 90 30 320
21555 19 6 5 35 15 138
21556 33 20 15 60 25 234
21557 40 12 20 113 30 398
21558 40 12 20 160 30 502
21600 20 0 25 55 19 251
21610 75 0 0 180 18 440
21615 25 0 25 91 23 334
21616 29 0 25 126 25 393
21620 22 0 25 65 21 285
21627 20 0 25 48 19 264
21630 34 0 25 147 30 597
21632 33 5 25 184 29 602
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
21685 50 10 15 75 30 440
21700 21 0 25 45 19 188
21705 26 0 25 84 22 273
21720 22 0 15 41 20 157
21725 26 0 25 89 22 258
21740 60 0 0 150 37 391
21742 0 0 0 0 0 0
21743 0 0 0 0 0 0
21750 60 0 0 120 25 306
21811 40 15 15 120 30 220
21812 40 15 15 150 30 250
21813 40 15 15 210 30 310
21820 11 0 0 17 7 59
21825 20 0 25 66 18 253
21899 0 0 0 0 0 0
21920 11 0 0 30 12 69
21925 17 0 15 29 17 145
21930 14 18 10 45 20 165
21931 33 20 15 60 20 206
21932 33 20 15 75 20 276
21933 40 20 20 90 25 315
21935 40 20 20 120 25 408
21936 40 20 20 160 30 510
22010 30 20 15 60 30 378
22015 30 15 15 60 30 373
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
22100 80 0 0 90 135 475
22101 75 0 0 90 135 490
22102 75 0 0 90 32 387
22103 0 0 0 30 0 30
22110 80 0 0 120 145 595
22112 90 0 0 150 175 675
22114 90 0 0 150 185 685
22116 0 0 0 45 0 45
22206 80 30 20 300 45 758
22207 80 30 20 300 45 758
22208 0 0 0 120 15 135
22210 105 0 0 180 185 763
22212 105 0 0 210 180 788
22214 100 0 0 200 170 763
22216 0 0 0 60 0 60
22220 105 0 0 165 180 733
22222 105 0 0 210 200 818
22224 105 0 0 225 175 808
22226 0 0 0 60 0 60
22305 18 0 15 34 11 121
22310 20 0 25 53 6 236
22315 55 0 0 30 80 315
22318 120 0 0 140 28 451
22319 120 0 0 150 30 483
22325 89 0 0 150 150 652
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
22326 95 0 0 120 145 600
22327 95 0 0 150 145 723
22328 0 0 0 45 0 45
22505 15 0 0 21 8 44
22510 23 15 5 45 20 150
22511 23 15 5 45 20 150
22512 0 1 0 30 1 32
22513 23 15 5 50 20 155
22514 23 15 5 45 20 150
22515 0 1 0 30 1 32
22526 20 15 15 45 15 145
22527 0 0 0 45 0 45
22532 120 0 0 170 30 583
22533 116 0 0 180 30 549
22534 0 0 0 60 0 60
22548 100 0 0 180 160 800
22551 60 18 20 120 30 395
22552 5 0 0 45 0 50
22554 60 20 15 90 30 362
22556 85 0 0 180 168 693
22558 80 0 0 180 150 650
22585 0 0 0 45 0 45
22586 40 20 20 180 30 500
22590 95 0 0 180 165 630
22595 90 0 0 150 160 650
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
22600 90 0 0 120 135 595
22610 88 0 0 150 138 656
22612 60 20 15 150 30 482
22614 0 0 0 40 0 40
22630 85 0 0 180 144 599
22632 0 0 0 60 0 60
22633 40 18 20 200 30 565
22634 0 0 0 70 0 70
22800 90 0 0 180 155 695
22802 90 0 0 200 170 670
22804 95 0 0 240 203 768
22808 90 0 0 180 191 691
22810 90 0 0 240 191 751
22812 90 0 0 270 191 854
22818 120 0 0 240 60 747
22819 120 0 0 245 60 795
22830 30 7 25 90 23 301
22840 0 0 0 60 0 60
22842 0 0 0 105 0 105
22843 0 0 0 120 0 120
22844 0 0 0 150 0 150
22845 0 0 0 90 0 90
22846 0 0 0 120 0 120
22847 0 0 0 120 0 120
22848 0 0 0 68 0 68
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
22849 36 10 25 121 29 397
22850 25 5 25 60 20 243
22851 0 0 0 90 0 90
22852 27 6 25 68 22 266
22853 45 45
22854 60 60
22855 35 9 25 136 27 418
22856 60 15 15 120 30 367
22857 60 20 15 180 45 550
22858 0 0 0 75 0 75
22859 60 60
22861 40 20 20 180 30 477
22862 70 20 15 240 45 620
22864 40 20 20 150 40 457
22865 75 20 15 210 30 600
22867 33 15 15 90 30 271
22868 45 45
22869 33 15 15 43 30 194
22870 30 30
22899 0 0 0 0 0 0
22900 33 3 15 60 20 244
22901 33 3 15 90 30 284
22902 14 1 10 45 20 148
22903 33 3 15 50 20 179
22904 40 3 20 120 30 396
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
22905 40 3 20 150 30 463
22999 0 0 0 0 0 0
23000 17 0 15 46 16 153
23020 23 0 25 81 21 292
23030 21 7 15 36 19 152
23031 14 0 15 35 14 94
23035 22 0 25 71 20 300
23040 23 0 25 74 21 305
23044 19 0 25 46 19 253
23065 15 0 0 23 18 64
23066 18 0 0 48 19 133
23071 33 20 15 45 20 191
23073 33 12 15 75 30 285
23075 14 10 10 30 20 142
23076 33 12 15 60 20 221
23077 40 20 20 140 30 433
23078 40 20 20 180 30 490
23100 21 0 25 57 19 216
23101 19 0 25 47 18 195
23105 25 0 25 92 22 276
23106 21 0 25 55 19 214
23107 25 0 25 75 23 260
23120 40 15 15 45 15 227
23125 27 0 25 92 23 279
23130 19 12 25 66 18 231
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
23140 22 0 25 71 20 242
23145 27 0 25 109 24 307
23146 24 0 25 86 22 269
23150 24 0 25 83 22 296
23155 27 0 25 120 23 355
23156 25 0 25 95 23 310
23170 20 0 25 59 19 247
23172 22 0 25 75 21 277
23174 24 8 25 101 26 352
23180 23 6 25 68 27 299
23182 24 0 25 88 27 314
23184 25 0 25 101 28 339
23190 23 0 25 76 21 249
23195 25 0 25 88 22 322
23200 40 12 20 155 30 497
23210 40 20 20 210 30 560
23220 40 12 20 240 30 602
23330 14 0 0 27 13 70
23333 33 12 15 45 15 178
23334 40 15 20 120 20 418
23335 40 15 20 140 30 448
23350 5 1 2 15 5 28
23395 60 0 0 160 30 423
23397 31 0 25 136 27 399
23400 29 0 25 104 27 315
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
23405 23 0 25 47 22 192
23406 25 0 25 62 23 239
23410 40 15 15 90 20 277
23412 40 15 15 100 20 287
23415 40 15 15 60 20 247
23420 45 15 15 120 20 328
23430 33 12 15 60 20 237
23440 25 0 25 62 21 208
23450 28 0 25 87 25 287
23455 30 0 25 104 26 307
23460 30 0 25 112 27 344
23462 29 0 25 104 27 327
23465 31 0 25 122 28 356
23466 45 0 0 120 30 348
23470 23 10 25 113 19 390
23472 40 15 20 140 30 448
23473 40 15 20 180 30 488
23474 40 15 20 205 30 513
23480 25 0 25 69 24 275
23485 28 0 25 101 25 331
23490 28 0 25 91 25 291
23491 30 0 25 104 26 315
23500 13 0 0 21 5 79
23505 16 0 15 32 10 121
23515 40 15 15 90 30 287
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
23520 13 0 0 20 9 82
23525 16 0 0 39 11 130
23530 23 0 15 77 20 210
23532 25 0 15 116 22 280
23540 13 0 0 20 9 82
23545 15 0 0 34 10 115
23550 24 0 25 75 19 267
23552 24 0 25 97 21 299
23570 13 0 0 20 9 82
23575 17 0 15 39 11 138
23585 60 23 15 120 33 407
23600 7 2 0 15 5 100
23605 19 0 15 44 11 172
23615 45 15 15 90 30 338
23616 50 15 15 120 30 413
23620 14 0 0 21 9 92
23625 16 0 15 35 10 151
23630 43 15 15 70 20 306
23650 24 0 15 32 14 133
23655 18 0 15 38 11 165
23660 22 0 25 84 20 245
23665 17 0 15 39 11 165
23670 40 15 15 90 30 326
23675 21 0 25 53 13 222
23680 45 15 15 120 30 361
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
23700 11 0 0 25 13 65
23800 31 0 25 125 27 378
23802 45 0 0 180 30 448
23900 37 6 25 187 34 537
23920 60 0 0 180 45 475
23921 24 0 25 67 21 241
23929 0 0 0 0 0 0
23930 13 0 0 31 13 92
23931 10 0 0 19 11 75
23935 19 0 25 58 17 233
24000 18 0 25 51 17 217
24006 60 0 0 60 20 282
24065 17 0 0 31 16 80
24066 20 0 15 51 19 172
24071 33 12 15 45 20 183
24073 33 20 15 75 20 283
24075 14 10 10 30 20 142
24076 33 20 15 60 20 229
24077 40 12 20 120 30 405
24079 40 12 20 150 30 472
24100 19 0 15 37 19 157
24101 21 0 25 49 19 189
24102 24 0 25 76 22 251
24105 18 0 15 35 19 143
24110 25 0 15 78 23 224
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
24115 28 0 25 110 24 339
24116 28 0 25 106 25 326
24120 23 0 15 61 21 195
24125 26 0 25 93 22 278
24126 25 0 25 79 21 272
24130 22 0 25 50 20 192
24134 24 0 25 79 23 303
24136 22 0 25 61 21 263
24138 22 0 25 50 24 277
24140 25 0 25 79 23 284
24145 23 0 25 66 22 240
24147 21 0 25 54 24 252
24149 60 0 0 170 30 456
24150 40 12 20 180 30 502
24152 33 12 15 150 30 440
24155 29 0 25 112 24 322
24160 40 12 20 120 30 405
24164 33 12 15 60 20 228
24200 14 0 0 26 12 68
24201 19 0 15 45 18 164
24220 15 0 0 20 8 43
24300 45 0 0 20 25 205
24301 27 0 25 87 25 266
24305 24 0 25 63 22 209
24310 20 0 25 40 19 171
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
24320 27 0 25 106 24 304
24330 26 0 25 86 24 263
24331 28 0 25 105 23 303
24332 50 0 0 60 30 230
24340 25 0 25 70 22 225
24341 45 0 0 90 30 318
24342 28 0 25 101 24 290
24343 55 0 0 90 30 281
24344 60 0 0 120 30 385
24345 58 0 0 90 30 284
24346 60 0 0 120 30 385
24357 30 10 10 20 15 168
24358 30 10 10 40 20 193
24359 30 10 10 60 20 213
24360 29 0 25 110 26 320
24361 31 0 25 108 28 322
24362 33 0 25 134 28 350
24363 40 12 20 140 20 435
24365 23 0 25 56 21 229
24366 24 0 25 68 22 243
24370 40 12 20 175 20 470
24371 40 12 20 210 20 505
24400 28 0 25 90 25 288
24410 33 0 25 129 29 344
24420 31 0 25 117 28 329
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
24430 30 18 15 102 15 343
24435 60 0 0 150 30 433
24470 24 0 25 63 22 236
24495 23 0 25 73 20 255
24498 28 0 25 100 23 308
24500 14 0 0 34 9 121
24505 20 0 15 50 12 188
24515 24 8 25 106 19 340
24516 80 0 0 90 20 352
24530 20 0 0 39 13 136
24535 23 0 15 55 14 206
24538 27 0 25 87 15 284
24545 40 20 15 120 30 361
24546 50 20 15 150 30 448
24560 16 0 0 36 10 118
24565 21 0 15 51 12 190
24566 60 0 0 60 45 257
24575 45 15 15 60 30 308
24576 17 0 0 37 11 129
24577 20 0 15 54 12 192
24579 45 15 15 90 30 338
24582 60 0 0 60 60 295
24586 28 6 25 120 26 375
24587 29 6 25 149 26 415
24600 17 0 15 29 12 121
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
24605 20 0 15 41 12 179
24615 22 0 25 75 21 277
24620 24 0 15 59 14 211
24635 40 10 15 60 30 291
24640 9 0 0 8 6 39
24650 11 0 0 20 8 87
24655 19 0 0 39 12 142
24665 23 0 25 77 21 256
24666 23 0 25 85 21 286
24670 15 0 0 29 10 102
24675 18 0 15 45 11 153
24685 40 15 10 60 30 252
24800 31 0 15 106 28 290
24802 30 0 25 138 26 399
24900 28 0 25 64 25 312
24920 21 0 25 51 21 282
24925 21 0 25 51 20 221
24930 22 0 25 60 23 294
24931 26 0 25 91 24 358
24935 30 0 25 148 27 458
24940 0 0 0 0 0 0
24999 0 0 0 0 0 0
25000 14 0 15 33 17 135
25001 30 0 0 30 20 154
25020 20 0 25 54 19 204
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
25023 27 0 25 100 28 400
25024 60 0 0 70 30 385
25025 60 0 0 125 30 460
25028 18 0 25 35 17 181
25031 17 0 15 34 16 141
25035 21 0 25 61 20 241
25040 19 0 25 48 19 227
25065 15 0 0 21 12 64
25066 17 0 15 40 17 156
25071 33 12 15 45 15 178
25073 33 12 15 60 20 221
25075 14 10 10 30 15 137
25076 33 12 15 45 20 206
25077 40 12 20 100 30 345
25078 40 12 20 120 30 422
25085 20 0 25 48 18 197
25100 17 0 15 35 16 142
25101 19 0 15 44 18 163
25105 22 0 15 69 20 201
25107 45 0 0 90 30 257
25109 25 10 15 40 20 191
25110 17 0 15 43 17 132
25111 17 0 15 41 19 140
25112 19 0 15 47 19 148
25115 45 0 0 90 30 257
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
25116 40 10 15 60 20 249
25118 18 0 15 40 18 158
25119 21 0 15 65 19 214
25120 22 0 15 66 20 217
25125 25 0 25 96 22 270
25126 24 0 25 88 21 260
25130 21 0 15 55 20 167
25135 25 0 15 89 22 234
25136 23 0 15 70 21 204
25145 22 0 15 73 21 225
25150 22 0 25 76 20 257
25151 23 0 25 83 21 266
25170 33 12 15 180 30 470
25210 21 0 25 53 20 194
25215 25 0 25 85 22 269
25230 19 0 25 42 18 190
25240 20 0 25 46 18 176
25246 9 6 0 19 12 46
25248 20 0 15 52 20 163
25250 22 0 15 72 21 205
25251 27 0 25 112 24 300
25259 46 0 0 20 20 201
25260 28 0 15 50 23 215
25263 28 0 15 53 23 229
25265 29 0 15 99 25 259
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
25270 21 0 15 46 19 176
25272 23 0 15 55 21 189
25274 27 0 15 93 24 242
25275 40 0 0 70 23 223
25280 22 0 25 53 20 195
25290 19 0 25 35 18 164
25295 22 0 25 48 21 191
25300 27 0 25 79 25 247
25301 26 0 25 78 23 235
25310 40 10 15 60 20 235
25312 27 0 25 96 24 284
25315 24 0 25 77 22 300
25316 28 0 25 109 24 356
25320 49 0 0 120 100 452
25332 28 0 25 106 25 314
25335 30 0 25 130 25 370
25337 45 0 0 90 75 353
25350 24 0 25 73 22 266
25355 25 0 25 84 23 289
25360 23 0 25 67 22 259
25365 29 0 25 116 24 354
25370 28 0 25 140 25 424
25375 34 0 25 134 29 382
25390 27 0 25 97 24 295
25391 29 0 25 124 25 383
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
25392 30 0 25 129 26 390
25393 32 0 25 158 27 432
25394 50 0 0 90 20 250
25400 27 0 25 99 25 308
25405 30 0 25 126 26 387
25415 30 0 25 135 27 367
25420 33 0 25 160 28 444
25425 28 0 25 104 26 343
25426 32 0 25 146 28 411
25430 50 0 0 100 30 270
25431 58 0 0 100 30 278
25440 27 0 25 90 24 278
25441 31 0 25 135 27 358
25442 30 0 25 131 25 331
25443 28 0 25 109 25 307
25444 29 0 25 105 25 304
25445 28 0 25 103 25 283
25446 31 0 25 141 28 425
25447 20 15 10 100 20 278
25449 31 0 25 135 28 369
25450 26 0 15 73 25 203
25455 29 0 15 99 26 260
25490 27 0 25 102 24 280
25491 27 0 25 93 24 271
25492 31 0 25 130 27 343
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
25500 8 0 0 23 5 84
25505 20 0 15 44 12 171
25515 40 10 10 60 30 247
25520 65 0 0 30 25 219
25525 45 10 15 70 20 303
25526 45 10 15 115 30 367
25530 7 0 0 25 8 88
25535 20 0 15 44 12 163
25545 40 10 10 60 30 286
25560 15 0 0 28 10 101
25565 9 0 15 52 15 182
25574 45 10 15 60 30 296
25575 45 10 15 90 30 342
25600 5 1 0 15 7 108
25605 14 1 5 30 13 169
25606 40 10 15 45 30 260
25607 40 10 15 60 30 275
25608 40 10 15 90 30 305
25609 40 10 15 120 30 358
25622 9 0 0 28 8 101
25624 19 0 0 44 12 155
25628 45 10 15 90 20 277
25630 11 0 0 25 7 91
25635 19 0 0 40 12 143
25645 22 0 15 71 20 222
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
25650 13 0 15 18 9 111
25651 50 0 0 30 20 190
25652 50 0 0 60 25 225
25660 20 0 0 41 12 145
25670 23 0 15 72 20 224
25671 50 0 0 45 25 210
25675 18 0 15 36 11 152
25676 25 0 25 66 14 242
25680 21 0 15 55 13 203
25685 24 0 25 86 22 279
25690 20 0 15 49 12 187
25695 23 0 25 81 21 244
25800 26 0 25 102 23 298
25805 29 0 25 123 24 351
25810 50 0 0 140 30 370
25820 24 0 15 77 23 222
25825 23 0 25 103 22 321
25830 45 0 0 100 70 310
25900 32 0 25 84 26 345
25905 21 0 25 53 21 264
25907 21 0 25 55 20 235
25909 23 0 25 64 21 257
25915 60 0 0 180 120 431
25920 22 0 25 57 21 249
25922 21 0 25 54 20 224
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
25924 21 0 25 52 20 242
25927 23 0 25 59 21 242
25929 22 0 25 55 20 226
25931 23 0 25 61 20 233
25999 0 0 0 0 0 0
26010 9 0 0 17 9 51
26011 11 0 0 29 13 69
26020 15 0 25 40 18 232
26025 16 0 25 37 16 200
26030 18 0 25 49 18 226
26034 18 0 25 49 18 250
26035 23 0 25 65 27 351.5
26037 18 0 25 51 18 228
26040 14 0 15 33 14 135
26045 22 0 15 75 20 207
26055 20 15 5 20 20 154
26060 13 0 15 18 13 91
26070 16 0 15 43 16 168
26075 16 0 15 39 16 164
26080 15 0 15 34 18 157
26100 16 0 15 32 16 119
26105 16 0 15 32 16 119
26110 16 0 15 27 16 114
26111 33 12 15 40 15 173
26113 33 12 15 58 15 214
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
26115 14 10 10 30 15 137
26116 33 12 15 45 15 201
26117 40 12 20 75 20 271
26118 40 12 20 100 20 368
26121 25 0 15 72 24 200
26123 45 0 0 120 28 308
26125 27 0 15 94 25 161
26130 21 0 15 50 19 180
26135 22 0 15 48 21 181
26140 20 0 15 44 20 174
26145 21 0 15 47 20 178
26160 20 15 5 20 20 154
26170 19 0 15 34 19 135
26180 20 0 15 42 20 153
26185 40 0 0 45 25 202
26200 19 0 15 44 19 164
26205 22 0 15 67 21 229
26210 20 0 15 44 20 155
26215 23 0 15 65 21 199
26230 19 0 15 47 19 186
26235 19 0 15 46 19 185
26236 17 0 15 36 17 171
26250 23 10 15 120 25 353
26260 23 10 15 90 20 256
26262 14 10 10 60 20 212
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
26320 17 0 15 43 16 150
26340 25 0 0 15 15 170
26341 10 1 5 10 10 52
26350 20 0 15 53 20 180
26352 25 0 15 94 22 258
26356 33 10 15 60 30 277
26357 33 10 15 85 30 302
26358 33 10 15 110 30 327
26370 22 0 25 59 21 221
26372 26 0 25 92 23 278
26373 24 0 25 75 22 258
26390 24 0 15 56 23 220
26392 25 0 25 69 23 254
26410 19 0 15 43 18 162
26412 22 0 15 64 20 215
26415 22 0 15 58 21 191
26416 24 0 15 71 23 216
26418 12 0 15 39 15 153
26420 23 0 15 72 20 224
26426 23 0 15 56 21 190
26428 25 0 15 72 23 218
26432 18 0 15 35 18 134
26433 20 0 15 46 19 148
26434 21 0 15 59 20 190
26437 22 0 15 51 20 183
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
26440 19 0 15 43 18 162
26442 45 0 0 90 30 280
26445 19 0 15 37 18 137
26449 45 0 0 90 25 275
26450 16 0 15 24 16 111
26455 16 0 15 26 16 113
26460 15 0 15 22 15 107
26471 22 0 15 57 21 171
26474 21 0 15 50 20 162
26476 20 0 15 43 19 153
26477 20 0 15 43 19 153
26478 22 0 15 49 21 163
26479 22 0 15 45 21 159
26480 33 9 15 60 15 222
26483 25 0 15 77 23 242
26485 24 0 15 70 22 233
26489 26 0 25 86 23 282
26490 25 0 15 75 24 241
26492 28 0 15 95 25 273
26494 25 0 15 78 23 243
26496 27 0 15 85 24 253
26497 25 0 15 84 23 249
26498 29 0 15 114 26 294
26499 27 0 15 104 24 272
26500 21 0 15 48 20 179
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
26502 23 0 15 70 21 223
26508 21 0 15 56 20 206
26510 28 0 15 91 26 254
26516 22 0 25 55 21 217
26517 25 0 25 75 23 260
26518 27 0 25 95 24 283
26520 21 0 15 45 20 176
26525 21 0 15 44 20 175
26530 25 0 15 59 23 205
26531 23 0 15 62 24 215
26535 23 0 15 62 21 196
26536 25 0 15 65 23 211
26540 21 0 15 54 20 204
26541 26 0 15 79 23 245
26542 23 0 15 67 21 220
26545 24 0 15 63 23 227
26546 45 0 0 90 30 341
26548 24 0 15 62 23 226
26550 60 0 0 240 120 491
26551 120 0 0 480 60 1004
26553 105 0 0 480 60 989
26554 120 0 0 595 60 1155
26555 60 0 0 180 90 401
26556 90 0 0 480 60 1004
26560 20 0 15 78 22 183
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
26561 20 0 15 99 22 258
26562 75 0 0 150 30 425
26565 23 0 15 59 22 194
26567 23 0 15 60 22 195
26568 25 0 15 74 23 239
26580 60 0 0 150 100 425
26587 60 0 0 180 90 401
26590 60 0 0 180 90 408
26591 25 0 15 81 23 222
26593 25 0 15 68 23 233
26596 25 0 15 64 23 210
26600 7 2 0 15 5 93
26605 15 0 0 27 9 107
26607 18 0 15 46 11 149
26608 50 0 0 38 20 191
26615 35 10 10 45 20 217
26641 16 0 15 33 10 138
26645 15 0 15 35 10 131
26650 30 10 10 30 20 197
26665 35 10 15 60 20 237
26670 14 0 0 30 9 101
26675 17 0 0 37 11 129
26676 19 0 15 53 12 171
26685 30 10 10 60 20 227
26686 20 0 15 73 19 231
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
26700 13 0 15 25 9 110
26705 17 0 15 35 11 142
26706 20 0 15 44 12 155
26715 38 10 15 40 20 220
26720 9 0 0 18 4 63
26725 16 0 0 30 10 104
26727 18 0 15 47 11 174
26735 40 10 10 60 20 237
26740 11 0 0 19 8 78
26742 14 0 0 33 9 104
26746 45 10 15 83 30 303
26750 10 0 0 16 7 65
26755 12 0 0 25 8 85
26756 18 0 15 38 11 146
26765 35 10 10 45 20 217
26770 12 0 0 26 8 86
26775 16 0 15 37 10 142
26776 19 0 15 43 11 152
26785 40 10 15 45 20 227
26820 26 0 15 88 23 254
26841 21 0 15 74 21 222
26842 25 0 15 84 22 258
26843 24 0 25 67 22 232
26844 26 0 25 89 23 275
26850 24 0 25 72 22 237
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
26852 25 0 25 88 22 272
26860 14 0 25 45 15 163
26861 0 0 0 36 0 36
26862 25 0 25 72 22 227
26863 0 0 0 67 0 67
26910 22 0 15 88 24 251
26951 20 15 5 30 20 203
26952 20 0 15 43 20 173
26989 0 0 0 0 0 0
26990 21 0 25 55 20 265
26991 19 0 25 40 19 229
26992 24 0 25 75 23 291
27000 14 0 25 14 16 147
27001 18 0 25 32 18 189
27003 22 0 25 54 22 267
27005 21 0 25 47 21 248
27006 20 0 25 47 20 254
27025 27 5 25 113 31 392.5
27027 43 12 5 60 30 359
27030 22 0 25 58 23 302
27033 24 0 25 77 24 342
27035 27 0 25 102 25 369
27036 60 0 0 120 30 380
27040 17 7 0 33 14 106
27041 22 0 25 68 21 250
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27043 33 20 15 60 20 206
27045 40 20 20 90 30 320
27047 14 18 10 40 20 160
27048 40 20 20 75 20 288
27049 40 3 20 180 30 496
27050 22 0 25 65 22 260
27052 60 0 0 90 30 327
27054 26 0 25 100 25 358
27057 43 12 5 90 30 389
27059 40 3 20 220 45 608
27060 20 0 25 53 20 254
27062 33 5 15 45 20 185
27065 24 0 25 83 23 329
27066 27 0 25 108 26 406
27067 29 0 25 136 25 443
27070 24 0 25 79 23 363
27071 26 0 25 103 25 409
27075 40 3 20 240 30 633
27076 40 20 20 360 40 840
27077 40 20 20 400 45 905
27078 40 20 20 240 45 665
27080 22 0 25 60 21 274
27086 16 0 0 36 14 82
27087 24 0 25 63 23 249
27090 26 0 25 78 26 317
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27091 41 13 25 178 30 577
27093 11 0 0 29 8 48
27095 11 0 0 33 8 52
27096 7 5 5 11 10 38
27097 22 0 25 60 20 271
27098 24 0 25 81 21 303
27100 28 0 25 114 24 311
27105 30 0 25 132 25 332
27110 29 0 25 125 26 365
27111 27 0 25 112 25 339
27120 30 0 25 143 29 515
27122 26 0 25 99 26 436
27125 27 9 25 84 27 430.5
27130 40 15 20 100 25 407
27132 32 10 25 194 30 611
27134 90 0 0 240 40 617
27137 75 0 0 180 30 492
27138 75 0 0 180 30 492
27140 26 0 25 98 24 335
27146 83 0 0 150 40 443
27147 83 0 0 180 40 473
27151 83 0 0 210 40 523
27156 83 0 0 225 40 538
27158 32 5 25 172 30 562
27161 29 0 25 129 28 489
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27165 30 0 25 147 28 531.5
27170 33 7 25 148 24 444
27175 12 0 25 43 12 308
27176 25 0 25 91 24 385
27177 29 0 25 149 26 477
27178 26 0 25 102 25 408
27179 28 0 25 123 26 442
27181 80 0 0 150 45 445
27185 23 0 25 79 21 320
27187 29 0 25 126 26 396
27193 25 0 0 40 10 188
27194 50 0 0 30 20 262
27197 12 5 10 27
27198 40 3 15 30 25 113
27200 15 0 0 16 8 63
27202 23 0 25 52 16 216
27215 40 15 20 120 20 388
27216 40 25 20 60 25 393
27217 40 15 20 120 25 443
27218 40 40 20 150 30 543
27220 18 0 25 34 13 264
27222 22 0 25 86 29 472
27226 90 0 0 120 20 412
27227 90 0 0 180 30 550
27228 80 0 0 300 30 680
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27230 24 0 25 30 4 205
27232 20 0 25 60 18 353
27235 23 0 25 82 18 360
27236 40 15 20 90 30 418
27238 24 0 25 47 7 207
27240 26 0 25 87 18 454
27244 40 30 20 75 30 438
27245 40 30 20 80 30 443
27246 13 0 25 16 9 141
27248 60 20 15 60 20 384
27250 15 5 5 15 13 53
27252 24 0 25 44 17 284
27253 24 0 25 89 24 344
27254 28 6 25 137 27 413
27256 15 0 15 39 11 154
27257 17 0 15 55 12 173
27258 26 6 25 112 26 395
27259 90 0 0 210 30 537
27265 18 0 15 22 12 150
27266 20 0 25 29 14 202
27267 7 0 2 15 5 171
27268 7 10 2 30 5 196
27269 25 15 20 125 30 404
27275 13 0 15 16 12 110
27279 40 18 15 60 30 244
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27280 40 18 15 120 30 383
27282 27 0 25 106 24 342
27284 80 0 0 180 30 497
27286 90 0 0 210 30 540
27290 37 6 25 218 33 615
27295 33 10 25 163 26 499
27299 0 0 0 0 0 0
27301 20 0 25 44 17 220
27303 22 0 25 57 21 249
27305 18 0 25 40 18 207
27306 16 0 25 27 16 162
27307 18 0 25 39 18 206
27310 19 0 25 54 21 311
27323 15 0 0 28 15 74
27324 18 0 25 41 17 168
27325 24 0 25 53 23 229
27326 21 0 25 56 19 215
27327 14 8 10 30 20 140
27328 33 20 15 60 20 261
27329 40 20 20 120 30 413
27330 19 0 25 36 18 165
27331 20 0 25 50 19 200
27332 20 0 25 61 27 235
27333 21 0 25 77 28 263
27334 23 0 25 73 21 294
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27335 26 0 25 94 22 329
27337 33 10 15 45 20 181
27339 40 20 20 90 20 310
27340 17 0 15 40 16 155
27345 22 0 25 62 20 204
27347 45 0 0 60 40 214
27350 22 0 25 70 20 289
27355 22 0 25 66 21 258
27356 24 0 25 88 22 331
27357 26 0 25 107 23 361
27358 0 0 0 118 0 118
27360 19 0 25 89 21 386
27364 40 20 20 180 30 550
27365 40 3 20 240 30 633
27370 6 0 0 24 13 43
27372 20 0 15 47 19 168
27380 21 0 25 57 18 235
27381 26 0 25 105 22 320
27385 33 9 15 60 30 237
27386 26 0 25 107 22 350
27390 17 0 25 30 16 184
27391 21 0 25 54 19 233
27392 24 0 25 80 21 292
27393 19 0 25 39 18 197
27394 23 0 25 66 20 248
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27395 28 0 25 112 23 348
27396 23 0 25 73 19 254
27397 60 0 0 120 30 360
27400 25 0 25 81 21 274
27403 24 0 25 74 20 257
27405 19 0 25 75 21 282
27407 26 0 25 105 23 349
27409 28 0 25 122 25 410
27412 45 15 15 180 30 484
27415 45 15 15 120 30 424
27416 55 10 15 90 20 287
27418 24 0 25 86 23 358
27420 25 0 25 81 22 295
27422 25 0 25 83 22 297
27424 25 0 25 85 21 298
27425 25 0 25 37 16 159
27427 26 0 25 91 18 302
27428 60 0 0 120 30 363
27429 60 0 0 180 30 466
27430 24 0 25 81 21 303
27435 60 0 0 90 40 340
27437 22 0 25 61 21 273
27438 24 0 25 78 23 332
27440 24 0 25 80 23 334
27441 25 0 25 94 24 360
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27442 19 0 25 94 17 307
27443 18 0 25 111 17 323
27445 23 8 25 131 20 447
27446 40 15 20 90 20 345
27447 40 15 20 100 25 407
27448 25 0 25 89 23 324
27450 30 0 25 132 25 392
27454 60 0 0 150 30 430
27455 27 0 25 105 25 344
27457 38 0 25 121 22 370
27465 32.5 20 12.5 120 22.5 383.5
27466 30 0 25 147 27 467
27468 33 5 25 175 29 515
27470 30 10 15 120 20 400
27472 32 5 25 164 28 502
27475 24 0 25 68 21 252
27477 25 0 25 76 22 262
27479 29 0 25 116 24 326
27485 23 0 25 59 20 241
27486 60 0 0 150 30 470
27487 60 0 0 200 30 520
27488 90 0 0 120 30 470
27495 29 0 25 131 27 452
27496 55 0 0 30 20 287
27497 55 0 0 60 20 301
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27498 65 0 0 60 20 327
27499 70 0 0 90 30 332
27500 10 0 25 46 9 216
27501 25 0 0 21 10 169
27502 23 0 25 59 19 328
27503 50 0 0 30 20 249
27506 30 26 25 119 30 501.5
27507 90 0 0 120 20 376
27508 18 0 25 38 8 221
27509 75 0 0 60 20 297
27510 23 0 25 52 16 298
27511 60 15 15 120 20 439
27513 60 15 15 145 20 464
27514 60 15 15 90 20 409
27516 21 0 25 46 13 215
27517 23 0 25 56 15 249
27519 60 15 15 80 20 359
27520 15 0 15 29 9 124
27524 19 0 25 78 20 274
27530 5 0 0 15 7 91
27532 21 0 25 47 13 218
27535 60 15 15 90 20 389
27536 60 0 0 175 30 475
27538 19 0 0 37 12 140
27540 60 15 15 75 20 334
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27550 20 0 0 38 13 143
27552 22 0 25 47 14 228
27556 60 15 15 90 20 369
27557 60 15 15 120 20 399
27558 60 15 15 150 20 429
27560 16 0 0 26 7 105
27562 20 0 15 38 12 168
27566 23 0 25 80 23 303
27570 10 0 15 21 9 71
27580 60 0 0 150 30 450
27590 23 0 25 69 20 449
27591 26 0 25 104 25 462
27592 21 0 25 57 23 358
27594 23 0 25 67 21 268
27596 24 0 25 83 23 345
27598 24 0 25 78 23 340
27599 0 0 0 0 0 0
27600 16 0 25 27 17 211
27601 16 0 25 28 17 220
27602 19 0 25 45 20 253
27603 19 0 25 25 16 199
27604 14 0 25 18 14 130
27605 15 0 15 30 12 88
27606 15 0 25 22 15 131
27607 19 0 25 42 21 281
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27610 18 0 25 49 17 311
27612 23 0 25 73 22 353
27613 15 0 0 32 14 77
27614 20 0 15 53 18 192
27615 40 23 20 120 30 416
27616 40 23 20 150 30 463
27618 14 10 10 30 15 137
27619 33 23 15 60 20 225
27620 20 0 15 50 20 180
27625 25 0 15 85 22 249
27626 27 0 15 101 23 268
27630 13 0 15 51 19 146
27632 33 12 15 45 20 183
27634 33 23 15 70 20 281
27635 24 0 25 85 21 267
27637 27 0 25 112 22 336
27638 27 0 25 96 25 315
27640 19 0 25 98 20 382
27641 23 0 25 78 21 319
27645 40 3 20 200 30 553
27646 40 20 20 180 40 540
27647 43 20 15 144 30 469
27648 9 0 0 23 9 41
27650 19 15 5 60 20 239
27652 25 0 25 92 20 312
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27654 33 15 5 90 20 283
27656 19 0 15 52 18 171
27658 20 0 25 49 16 196
27659 22 0 25 67 18 246
27664 19 0 25 45 17 173
27665 21 0 25 61 19 201
27675 24 0 15 73 22 228
27676 22 0 15 91 24 274
27680 20 0 25 47 19 197
27681 22 0 25 62 19 232
27685 17 0 25 55 20 200
27686 23 0 25 71 19 252
27687 21 0 25 59 19 199
27690 33 10 15 60 20 258
27691 33 10 15 75 20 292
27692 0 0 0 44 0 44
27695 21 0 25 57 20 225
27696 25 0 25 88 20 280
27698 27 0 25 91 20 275
27700 26 0 25 104 23 310
27702 30 0 25 135 26 416
27703 30 0 25 148 27 488
27704 24 0 25 78 22 251
27705 25 0 25 78 23 303
27707 19 0 25 47 18 243
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27709 40 17.5 10 107.5 15 346
27712 60 0 0 120 30 400
27715 27 0 25 119 26 457
27720 28 0 25 109 24 356
27722 29 0 25 129 26 389
27724 90 0 0 180 30 460
27725 60 0 0 150 30 464
27726 40 15 15 100 20 319
27727 30 0 25 146 26 445
27730 22 0 25 60 20 241
27732 20 0 25 52 19 183
27734 24 0 25 79 21 273
27740 27 0 25 117 24 315
27742 29 0 25 131 25 340
27745 26 0 25 96 23 312
27750 19 0 0 35 14 143
27752 13 0 25 51 19 250
27756 23 0 25 91 23 344
27758 37 0 25 126 27 435
27759 65 0 0 90 20 324
27760 22 0 0 32 6 124
27762 23 0 15 46 18 212
27766 40 10 15 45 20 266
27767 0 5 0 15 5 96
27768 30 10 5 25 10 170
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27769 45 15 15 60 15 279
27780 15 0 0 29 10 110
27781 17 0 15 39 11 146
27784 40 10 15 60 20 281
27786 14 0 0 33 11 114
27788 18 0 15 40 11 148
27792 33 10 15 60 30 245
27808 16 0 0 37 10 127
27810 19 0 15 52 11 180
27814 45 10 15 90 30 346
27816 17 0 0 36 10 119
27818 19 0 25 54 12 193
27822 45 10 15 90 30 353
27823 45 15 15 98 30 366
27824 25 0 0 47 10 137
27825 119 0 0 60 20 345
27826 45 15 15 60 30 328
27827 55 15 15 120 30 441
27828 55 15 15 150 30 471
27829 45 10 15 45 20 271
27830 16 0 25 26 10 152
27831 17 0 25 39 10 166
27832 45 10 15 75 20 301
27840 22 0 15 29 11 160
27842 26 0 25 40 22 225
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
27846 23 0 25 90 22 312
27848 25 0 25 109 23 334
27860 18 0 15 36 20 105
27870 60 0 0 140 30 400
27871 26 0 25 97 21 301
27880 30 15 15 80 20 400
27881 26 0 25 109 40 468
27882 20 0 25 53 21 331
27884 22 0 25 62 21 292
27886 23 0 25 80 22 340
27888 23 0 25 75 22 335
27889 23 0 25 70 23 361
27892 65 0 0 60 20 307
27893 65 0 0 60 20 307
27894 60 0 0 90 30 433
27899 0 0 0 0 0 0
28001 10 0 0 31 10 67
28002 30 3 15 30 20 163
28003 33 3 15 53 20 323
28005 18 0 25 62 15 320
28008 18 0 15 42 17 159
28010 15 0 0 20 15 90
28011 18 0 0 39 18 123
28020 18 0 15 44 17 161
28022 18 0 15 40 17 157
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
28024 17 0 15 36 16 151
28035 20 0 15 48 19 169
28039 19 6 5 45 20 153
28041 33 8 15 60 20 217
28043 19 6 5 30 20 138
28045 19 6 5 45 20 169
28046 33 8 15 90 25 334
28047 40 8 20 120 25 413
28050 17 0 25 38 16 163
28052 17 0 25 32 16 149
28054 15 0 15 29 15 133
28055 18 0 15 54 24 197
28060 21 0 15 43 21 156
28062 24 0 15 85 22 221
28070 19 0 15 52 18 190
28072 19 0 15 47 18 166
28080 20 0 0 30 20 169
28086 18 0 25 44 18 172
28088 17 0 15 35 16 142
28090 19 0 0 44 19 130
28092 17 0 0 33 17 115
28100 21 0 15 64 20 195
28102 26 0 25 97 23 273
28103 24 0 15 79 21 233
28104 20 0 15 52 19 173
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
28106 25 0 15 78 23 243
28107 22 0 15 81 20 232
28108 18 0 15 35 18 134
28110 17 0 15 35 17 151
28111 18 0 25 44 17 171
28112 18 0 25 36 17 163
28113 20 0 0 30 20 178
28114 30 0 0 90 30 339
28116 60 0 0 80 30 320
28118 21 0 25 56 19 196
28119 21 0 15 52 20 183
28120 33 10 15 50 30 251
28122 33 10 15 45 30 249
28124 17 0 15 34 21 151
28126 16 0 15 29 16 116
28130 60 0 0 90 30 330
28140 21 0 25 58 20 228
28150 17 0 15 35 17 151
28153 16 0 15 29 15 142
28160 17 0 15 33 16 129
28171 43 20 15 120 30 365
28173 19 3 5 110 30 304
28175 19 3 5 60 20 205
28190 9 0 0 30 9 64
28192 19 0 15 41 18 141
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
28193 21 0 15 58 20 189
28200 19 0 15 49 18 149
28202 22 0 25 70 19 240
28208 18 0 15 37 17 154
28210 20 0 25 51 19 209
28220 17 0 15 34 16 149
28222 20 0 15 55 18 175
28225 16 0 15 28 15 133
28226 18 0 15 45 17 162
28230 17 0 15 35 17 143
28232 15 0 15 22 15 107
28234 15 0 15 18 18 122
28238 23 0 25 75 21 248
28240 16 0 15 33 16 139
28250 20 0 15 43 19 164
28260 22 0 25 53 21 225
28261 60 0 0 103 30 343
28262 60 0 0 140 30 380
28264 25 0 25 74 23 269
28270 19 0 15 37 18 145
28272 16 0 15 26 16 113
28280 19 0 15 48 18 167
28285 30 3 15 30 15 190
28286 19 0 15 46 17 145
28288 20 0 0 30 20 169
-
CMS Time Table for Use with
Prolonged Services Without Direct Face-to-Face Contact
cpt_code
Pre_Evaluation_
Time
Pre_Positioning_t
ime
Pre_Service_Scrub_
Dress_Wait_tim
Median_Intra_Se
rvice_Time
Immediate_post_Se
rvice_time Total_time
28289 33 10 10 45 15 210
28290 21 0 15 44 20 175
28291 33 10 10 50 15 215
28292 33 10 10 45 15 226
28293 30 0 0 80 30 318
28294 25 0 15 87 23 252
28295 33 10 10 60 15 241
Related Documents
