99358 Denied As Not Reimbursable

For incorrectly denied or underpaid Original bills, DaisyBill advises filing a Second Review.

Official Medical Fee Schedule

Physician Services

CPT Code(s)

99358, 99359 (add-on code)



EOR Denial Reason

Does not fall under the fee schedule guidelines of a reimbursable report.

Second Review Reason (SBR-1 Form)

Recommended Reason (example of 99214 incorrectly downcoded to 99213)

The AMA CPT Definition of 99358 is as follows: Prolonged evaluation and management service before and/or after direct patient care; first hour. For dates of service on or after 3/1/2017 RBRVS indicate 99358 with a payment status code of "A" payable.

Please pay accordingly.

DaisyBill Resources

Webinar: CPT Codes 99358 and 99359 - Non-Face-to-Face Service

e-Booklet: 99358 and 99359 Resource Notebook

Blog: The 5 Point Checklist for CPT Codes 99358 and 99359

DaisyBill Solution

Every request for Second Review submitted from DaisyBill is compliantly submitted using both a completed DWC Form SBR-1, as well as a compliant modified CMS 1500.


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