cme.jax.ufl.educme.jax.ufl.edu/college-of-medicine/compliance/documents/cms-time-table.pdfCMS Time...
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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
Transcript of cme.jax.ufl.educme.jax.ufl.edu/college-of-medicine/compliance/documents/cms-time-table.pdfCMS Time...
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
28296 33 10 10 60 15 241
28297 33 10 10 75 15 256
28298 33 10 10 60 15 225
28299 33 10 10 75 15 256
28300 25 0 25 62 23 218
28302 25 0 25 59 23 234
28304 23 0 25 57 22 239
28305 26 0 25 88 24 283
28306 20 0 25 51 19 163
28307 23 0 25 70 20 213
28308 17 0 25 39 20 165
28309 60 0 0 110 30 350
28310 19 0 15 46 18 165
28312 18 0 15 43 17 160
28313 18 0 15 34 17 151
28315 18 0 15 39 17 156
28320 26 0 15 87 24 254
28322 25 0 15 75 23 221
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
28340 23 0 15 78 20 230
28341 25 0 25 104 22 298
28344 16 0 25 43 15 185
28345 21 0 25 63 19 222
28360 60 0 0 120 100 395
28400 13 0 0 28 8 97
28405 17 0 15 47 10 164
28406 22 0 25 57 13 229
28415 55 15 15 120 30 441
28420 60 20 15 150 30 481
28430 11 0 0 30 8 89
28435 15 0 0 44 9 116
28436 20 0 15 60 12 190
28445 58 15 15 120 30 444
28446 45 10 10 120 15 339
28450 11 0 0 28 8 87
28455 14 0 0 42 9 113
28456 21 0 15 59 12 182
28465 45 10 15 60 30 257
28470 7 2 0 15 5 77
28475 13 0 0 35 8 80.5
28476 19 0 15 50 12 168
28485 40 10 15 60 20 242
28490 10 0 0 23 7 64
28495 13 0 0 36 8 89
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
28496 18 0 15 50 11 142
28505 40 10 15 45 20 227
28510 8 0 0 15 6 53
28515 10 0 0 22 7 71
28525 35 10 15 30 20 207
28530 10 0 0 23 7 56
28531 55 0 0 60 20 225
28540 13 0 0 36 9 106
28545 17 0 15 33 10 142
28546 21 0 15 53 12 184
28555 40 10 15 60 20 281
28570 14 0 0 37 9 92
28575 18 0 15 40 11 178
28576 70 0 0 45 20 277
28585 45 10 15 75 20 324
28600 15 0 0 40 10 105
28605 18 0 15 37 11 156
28606 22 0 25 62 13 224
28615 45 10 15 60 18 323
28630 11 0 0 20 8 55
28635 13 0 0 24 8 61
28636 20 5 10 27 15 77
28645 35 10 15 45 15 217
28660 10 0 0 16 7 49
28665 10 0 0 20 7 53
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
28666 20 5 10 37 15 87
28675 30 10 15 30 15 197
28705 75 0 0 180 35 490
28715 40 3 15 125 40 366
28725 33 10 15 90 30 298
28730 33 10 15 100 30 308
28735 60 0 0 120 30 360
28737 60 0 0 100 30 340
28740 45 0 0 80 30 266
28750 40 0 0 75 30 237
28755 19 0 25 44 17 172
28760 60 0 0 90 30 330
28800 22 0 25 69 20 306
28805 30 15 15 60 20 376
28810 19 0 25 47 18 251
28820 33 10 15 30 30 215
28825 33 10 15 30 20 205
28890 15 5 10 25 18 140
28899 0 0 0 0 0 0
29000 15 0 0 58 15 88
29010 14 0 0 53 15 82
29015 15 0 0 70 16 101
29035 13 0 0 50 14 77
29040 15 0 0 66 15 96
29044 14 0 0 65 15 94
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
29046 16 0 0 81 16 113
29049 9 0 0 26 10 45
29055 13 0 0 47 14 74
29058 11 0 0 38 12 61
29065 8 0 0 25 9 42
29075 5 1 1 15 5 27
29085 8 0 0 25 9 42
29086 20 0 0 13 10 43
29105 8 0 0 26 9 43
29125 5 0 0 15 3 23
29126 5 0 0 30 3 38
29130 6 0 0 15 6 27
29131 7 0 0 18 5 30
29200 7 0 0 9 2 18
29240 7 0 0 9 2 18
29260 7 0 0 9 2 18
29280 7 0 0 9 2 18
29305 13 0 0 52 14 79
29325 14 0 0 64 15 93
29345 11 0 0 38 12 61
29355 11 0 0 41 12 64
29358 11 0 0 49 12 72
29365 10 0 0 29 10 49
29405 7 0 0 15 5 27
29425 7 0 0 15 5 27
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
29435 10 0 0 36 11 57
29440 6 0 0 14 7 27
29445 15 0 0 30 5 50
29450 10 0 0 20 5 35
29505 9 0 0 22 10 41
29515 5 0 0 15 3 23
29520 7 0 0 9 2 18
29530 7 0 0 9 2 18
29540 7 0 0 9 2 18
29550 5 0 0 5 1 11
29580 5 2 1 12 7 27
29581 7 0 0 15 5 27
29582 4 0 0 12 2 18
29583 4 0 0 10 2 16
29584 4 0 0 12 2 18
29700 9 0 0 23 10 42
29705 11 0 0 33 11 55
29710 11 0 0 39 11 61
29720 10 0 0 21 10 41
29730 7 0 0 16 8 31
29740 11 0 0 29 11 51
29750 11 0 0 23 11 45
29799 0 0 0 0 0 0
29800 30 0 0 47 10 161
29804 35 0 0 64 10 206
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
29805 18 7 15 48 18 154
29806 55 0 0 100 30 298
29807 55 0 0 90 30 288
29819 24 0 15 61 21 196
29820 24 0 15 63 20 189
29821 25 5 15 82 21 223
29822 24 0 15 69 21 204
29823 23 9 15 84 16 230
29824 48 0 0 60 20 225
29825 25 0 15 76 21 212
29826 0 0 0 40 0 40
29827 75 0 0 120 40 334
29828 33 12 15 75 20 252
29830 16 0 15 44 17 132
29834 17 0 15 55 18 153
29835 23 0 15 55 19 160
29836 25 5 15 74 21 196
29837 23 0 15 59 20 165
29838 25 5 15 79 21 220
29840 20 0 15 45 18 146
29843 22 0 15 53 19 157
29844 22 0 15 56 19 160
29845 25 5 15 77 21 199
29846 24 0 15 72 20 179
29847 24 5 15 77 21 190
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
29848 45 0 0 45 20 179
29850 23 15 10 60 17 192
29851 35 15 10 90 20 274
29855 30 15 10 95 8 255
29856 30 15 10 135 8 314
29860 75 0 0 70 30 244
29861 75 0 0 80 30 254
29862 75 0 0 100 30 297
29863 75 0 0 100 30 297
29866 45 15 15 100 20 308
29867 45 15 15 120 30 404
29868 45 15 15 180 30 484
29870 17 0 15 42 15 129
29871 22 0 25 51 19 184
29873 75 0 0 45 30 249
29874 23 0 15 56 20 181
29875 15 8 15 65 17 168
29876 25 5 15 79 21 233
29877 21 5 15 69 18 197
29879 25 0 15 68 21 217
29880 33 10 15 45 15 199
29881 33 10 15 40 15 194
29882 27 5 15 87 22 244
29883 75 0 0 90 30 311
29884 22 0 15 64 19 208
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
29885 25 0 15 90 21 250.5
29886 24 0 15 73 21 221
29887 27 6 15 91 23 261.5
29888 45 15 15 98 25 295
29889 90 0 0 150 30 433
29891 50 0 0 60 25 227
29892 60 0 0 90 30 272
29893 60 0 0 30 40 247
29894 24 0 15 53 20 179
29895 23 0 15 53 20 178
29897 24 0 15 60 20 186
29898 28 0 15 79 25 222
29899 75 0 0 120 30 395
29900 50 0 0 60 20 220
29901 50 0 0 75 20 235
29902 50 0 0 90 20 250
29904 40 15 10 60 15 228
29905 40 15 10 60 15 244
29906 40 15 10 60 15 244
29907 40 15 10 90 15 293
29914 33 20 10 100 20 280
29915 33 20 10 90 20 270
29916 33 20 10 90 20 270
29999 0 0 0 0 0 0
30000 9 0 0 23 8 56
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
30020 9 0 0 24 8 57
30100 9 0 0 12 9 30
30110 12 0 0 22 12 62
30115 17 0 15 44 12 120
30117 15 0 15 34 14 110
30118 29 0 25 105 25 288
30120 22 0 15 63 20 160
30124 17 0 0 33 19 101
30125 25 0 15 102 24 252
30130 15 0 15 27 14 122
30140 15 0 15 28 14 120
30150 25 0 25 67 16 267
30160 29 0 25 89 25 302
30200 7 0 0 11 7 25
30210 6 0 0 11 6 39
30220 9 0 0 18 8 51
30300 8 0 0 13 9 46
30310 11 0 15 16 10 68
30320 21 0 15 55 20 151
30400 33 0 0 90 45 312
30410 45 0 0 120 53 362
30420 45 0 0 150 60 399
30430 40 0 0 60 30 274
30435 45 0 0 120 45 354
30450 60 0 0 150 60 414
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
30460 30 0 0 133 30 232
30462 60 0 0 220 30 388
30465 30 0 0 120 30 277
30520 13.5 10 15 60 15 210.5
30540 23 0 15 64 19 196
30545 27 0 15 130 21 305
30560 9 0 0 12 9 46
30580 42 0 0 66 32 204
30600 26 0 0 70 23 167
30620 21 0 15 79 17 234
30630 26 0 15 124 20 260
30801 10 0 0 10 10 46
30802 10 0 0 20 10 56
30901 6 0 5 10 5 26
30903 20 0 0 30 20 70
30905 30 0 0 48 30 108
30906 30 0 0 60 40 130
30915 28 0 25 67 24 242
30920 60 0 0 120 35 428
30930 8 0 15 10 7 56
30999 0 0 0 0 0 0
31000 7 0 0 22 7 52
31002 11 0 0 26 9 62
31020 14 0 15 25 11 105
31030 17 0 15 54 11 167
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
31032 21 0 25 49 38 211
31040 25 0 25 112 14 300
31050 19 0 25 39 13 147
31051 21 0 25 48 18 179
31070 16 0 25 29 15 144
31075 23 0 25 76 15 263
31080 27 0 25 129 22 343
31081 28 0 25 129 23 365
31084 29 0 25 150 23 387
31085 30 0 25 161 24 400
31086 27 0 25 125 23 370
31087 30 0 25 160 30 423.5
31090 75 0 0 120 30 425
31200 24 0 15 48 24 186
31201 21 0 25 62 25 237
31205 20 0 25 73 16 258
31225 45 15 20 180 30 608
31230 60 15 20 225 30 688
31231 5 1 5 7 3 21
31233 15 0 0 20 15 50
31235 20 0 0 35 20 75
31237 17 1 5 20 5 48
31238 12 1 5 25 10 53
31239 33 3 10 60 20 168
31240 25 3 10 20 15 73
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
31254 30 0 0 48 30 108
31255 30 0 0 68 30 128
31256 18 0 15 45 18 96
31267 30 0 0 50 30 110
31276 30 0 0 75 30 135
31287 30 0 0 45 30 105
31288 30 0 0 60 30 120
31290 120 0 0 180 45 578
31291 120 0 0 180 48 581
31292 90 0 0 140 30 453
31293 90 0 0 180 45 528
31294 100 0 0 210 40 563
31295 30 3 10 20 15 78
31296 30 3 10 30 15 88
31297 30 3 10 28 15 86
31299 0 0 0 0 0 0
31300 32 0 25 141 26 414
31320 27 0 25 89 24 309
31360 60 15 20 200 35 768
31365 60 15 20 300 40 893
31367 60 15 20 180 35 728
31368 60 15 20 285 40 858
31370 60 15 20 180 35 728
31375 60 15 20 150 35 698
31380 60 15 20 160 35 708
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
31382 60 15 20 180 35 728
31390 60 15 20 360 40 988
31395 60 15 20 400 40 1048
31400 31 0 25 126 27 481
31420 28 0 25 104 25 436
31500 10 1 1 10 10 32
31502 5 0 0 10 10 25
31505 5 0 0 7 5 17
31510 12 0 0 20 13 45
31511 12 0 0 25 13 50
31512 17 0 15 20 14 66
31513 13 0 0 30 14 57
31515 14 0 0 26 14 54
31520 14 0 15 15 14 58
31525 14 0 0 19 14 47
31526 15 0 15 32 16 78
31527 18 0 15 47 18 98
31528 16 0 0 39 16 71
31529 16 0 25 35 16 92
31530 18 0 15 35 18 86
31531 19 0 15 39 19 92
31535 20 0 15 24 13 72
31536 17 0 15 39 12 83
31540 23 0 15 38 21 97
31541 45 0 0 60 20 125
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
31545 40 10 10 60 15 154
31546 40 10 10 90 20 189
31551 40 3 15 180 33 658
31552 40 3 15 180 30 505
31553 40 3 15 180 33 718
31554 40 3 15 195 30 540
31560 23 0 25 62 22 132
31561 60 0 0 90 30 218
31570 19 0 15 39 19 92
31571 45 0 0 40 25 129
31572 20 1 9 20 10 60
31573 17 1 9 15 10 52
31574 20 1 9 15 10 55
31575 8 1 5 5 5 24
31576 15 1 9 10 10 45
31577 13 1 9 15 10 48
31578 16 1 9 15 10 51
31579 8 1 5 10 10 34
31580 40 3 15 120 30 405
31582 45 0 0 210 60 687
31584 40 3 15 120 30 445
31587 40 3 15 95 30 445
31588 45 0 0 150 40 416
31590 60 0 0 90 30 291
31591 33 1 5 120 28 275
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
31592 40 3 15 240 33 738
31595 23 0 25 56 22 272
31599 0 0 0 0 0 0
31600 50 0 0 40 66 156
31601 60 0 0 45 30 135
31603 20 0 0 30 43 93
31605 13 0 25 10 19 67
31610 22 0 25 61 21 295
31611 19 0 25 43 18 164
31612 11 0 25 9 12 57
31613 17 0 15 33 12 155
31614 40 0 0 60 30 346
31615 8 0 25 20 14 67
31622 8 3 5 30 15 61
31623 15 0 0 30 20 65
31624 15 0 0 30 20 65
31625 10 3 5 35 15 68
31626 10 3 5 45 20 83
31627 0 0 0 60 0 60
31628 10 3 5 40 20 78
31629 10 3 5 35 20 73
31630 20 15 15 45 30 125
31631 20 10 15 45 30 120
31632 0 0 0 18 0 18
31633 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
31634 14 1 5 45 20 85
31635 13 0 25 39 19 96
31636 15 15 15 45 25 115
31637 0 0 0 30 0 30
31638 20 15 15 60 30 140
31640 23 0 25 59 23 130
31641 23 0 25 70 23 141
31643 30 0 0 35 30 95
31645 17 0 25 43 16 101
31646 12 0 25 31 18 86
31647 14 1 5 60 30 110
31648 14 1 5 45 30 95
31649 0 0 0 30 0 30
31651 0 0 0 30 0 30
31652 14 3 5 60 25 107
31653 14 3 5 75 25 122
31654 0 0 0 30 0 30
31660 14 1 5 50 30 100
31661 14 1 5 60 30 110
31717 12 0 15 23 11 61
31720 8 0 15 10 8 41
31725 2 0 15 21 11 49
31730 10 0 0 69 10 89
31750 60 0 0 180 30 540
31755 60 0 0 180 0 414
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
31760 47 31 25 220 38 623
31766 48 35 25 360 44 788
31770 39 28 25 179 43 544
31775 39 27 25 187 41 557
31780 60 0 0 180 50 619
31781 40 27 25 201 41 602
31785 37 24 25 171 37 524
31786 45 32 25 290 42 722
31800 22 0 25 66 20 301
31805 36 13 25 170 30 382
31820 17 0 15 40 16 168
31825 22 0 15 67 20 230
31830 19 0 15 43 17 153
31899 0 0 0 0 0 0
32035 32 24 25 102 23 667
32036 35 24 25 106 23 674
32096 40 15 20 60 30 436
32097 40 15 20 80 30 401
32098 40 15 20 60 30 341
32100 40 15 20 90 30 411
32110 60 0 0 150 45 561
32120 35 23 25 96 35 647
32124 33 23 25 172 30 696
32140 35 24 25 137 30 664
32141 60 15 20 116 40 673
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
32150 34 23 25 115 26 626
32151 36 24 25 128 30 656
32160 10 11 25 126 48 788
32200 36 23 25 90 24 691
32215 28 26 25 92 32 471
32220 90 0 0 180 86 722
32225 36 27 25 170 35 716
32310 34 0 25 136 33 516
32320 90 0 0 180 45 735
32400 18 8 25 29 19 99
32405 14 1 5 30 20 70
32440 90 0 0 160 40 628
32442 60 15 20 286 60 1035
32445 60 15 20 310 40 1182
32480 90 0 0 155 30 593
32482 95 0 0 198 45 680
32484 60 15 20 139 40 561
32486 60 15 20 240 40 812
32488 60 15 20 194 40 836
32491 90 0 0 150 60 887
32501 0 0 0 25 0 25
32503 60 15 25 240 45 645
32504 60 15 25 300 45 705
32505 40 15 20 90 30 427
32506 0 0 0 25 0 25
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
32507 0 0 0 30 0 30
32540 60 15 20 120 40 740
32550 10 15 10 30 20 85
32551 20 3 10 20 20 73
32552 13 1 6 15 12 82
32553 9 1 5 45 20 80
32554 13 3 5 20 15 56
32555 13 3 6 20 15 57
32556 13 3 6 20 18 60
32557 13 3 6 30 15 67
32560 18 1 6 20 20 65
32561 13 1 6 15 10 45
32562 13 1 6 10 10 40
32601 28 15 20 60 30 193
32604 83 0 0 108 120 311
32606 90 0 0 90 120 300
32607 28 15 20 45 30 178
32608 30 15 20 60 30 195
32609 28 15 20 45 30 178
32650 60 0 0 90 140 400
32651 60 15 20 70 40 502
32652 60 15 20 160 40 645
32653 60 15 20 77 40 509
32654 10 12 15 71 40 515
32655 60 15 20 73 40 425
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
32656 60 0 0 150 170 517
32658 90 0 0 120 120 420
32659 90 0 0 120 165 492
32661 60 0 0 120 130 400
32662 60 15 20 98 40 350
32663 40 15 20 155 30 507
32664 90 0 0 120 120 420
32665 60 15 20 105 40 512
32666 40 15 20 75 30 332
32667 0 0 0 25 0 25
32668 0 0 0 30 0 30
32669 40 15 20 150 30 502
32670 40 15 20 180 30 532
32671 40 15 20 180 30 602
32672 40 15 20 120 30 567
32673 40 15 20 150 30 447
32674 0 0 0 30 0 30
32701 18 1 6 60 15 100
32800 38 29 25 130 38 578
32810 35 26 25 102 37 523
32815 60 15 20 155 40 1147
32820 90 0 0 215 240 1054
32850 150 0 0 180 120 450
32851 80 30 30 240 90 1165
32852 80 30 30 300 90 1320
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
32853 80 20 30 375 90 1440
32854 80 20 30 400 90 1600
32855 0 0 0 0 0 0
32856 0 0 0 0 0 0
32900 25 18 25 180 45 821
32905 39 29 25 211 34 721
32906 34 29 25 246 34 751
32940 30 0 25 173 25 546
32960 13 0 15 35 12 75
32997 40 0 0 90 110 424
32998 15 15 15 60 30 135
32999 0 0 0 0 0 0
33010 9 0 15 24 27 75
33011 9 0 25 26 18 78
33015 24 18 25 38 22 384.5
33020 30 24 25 85 38 565
33025 19 14 25 66 30 410
33030 40 3 20 180 45 739
33031 40 3 20 205 48 839
33050 34 0 25 130 41 623
33120 40 3 20 205 60 686
33130 45 31 25 150 45 719
33140 60 15 20 113 40 621
33141 0 0 0 19 0 32.20000004
33202 55 15 15 65 30 301
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
33203 55 15 15 90 30 326
33206 14 15 25 59 23 248.5
33207 10 12.5 20 60 30 233.5
33208 10 15 15 60 30 231
33210 20 0 0 30 30 80
33211 50 0 0 45 45 140
33212 10 1 6 45 20 124
33213 10 1 6 46 20 125
33214 50 0 0 120 60 262
33215 20 0 0 60 25 179
33216 50 0 0 90 90 262
33217 50 0 0 120 60 262
33218 50 0 0 90 60 246
33220 50 0 0 120 60 276
33221 10 1 6 50 20 129
33222 55 0 0 112 60 275
33223 48 0 0 90 60 230
33224 20 0 0 135 30 204
33225 0 0 0 120 0 120
33226 25 0 0 120 25 189
33227 10 1 6 45 20 124
33228 10 1 6 50 20 129
33229 10 1 6 60 20 139
33230 10 3 15 60 20 150
33231 10 3 15 60 20 150
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
33233 35 0 0 53 30 150
33234 50 0 0 150 60 292
33235 50 0 0 170 60 390
33236 30 0 0 120 60 376
33237 60 0 0 180 90 516
33238 60 0 0 180 75 517
33240 10 3 15 45 20 135
33241 35 0 0 60 60 171
33243 90 0 0 210 135 642
33244 50 0 0 180 0 310
33249 50 0 0 120 0 239
33250 61 38 25 230 31 983
33251 53 37 25 250 38 1001
33254 60 15 20 120 40 416
33255 60 15 20 180 40 516
33256 60 15 20 200 40 646
33257 15 0 0 30 15 180.3499998
33258 15 0 0 45 15 190.2999982
33259 15 0 0 48 15 222.7500026
33261 53 37 25 250 41 1004
33262 10 3 15 60 20 150
33263 10 3 15 60 20 150
33264 10 3 15 60 20 150
33265 60 15 20 150 40 446
33266 60 15 20 200 40 536
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
33270 33 1 5 90 25 232
33271 33 1 5 60 25 202
33272 33 1 5 45 25 151
33273 33 1 5 60 25 202
33282 14 1 5 25 15 102
33284 14 1 5 20 10 92
33300 10 12 15 144 40 859
33305 10 12 15 296 40 1251
33310 28 31 25 126 34 532
33315 40 3 20 180 60 621
33320 25 12 25 129 53 516.5
33321 240 0 0 240 225 949
33322 41 30 25 175 50 884
33330 47 34 25 187 50 916
33335 48 36 25 219 52 963
33340 40 3 20 90 30 183
33361 45 15 20 135 45 330
33362 45 15 20 150 45 345
33363 45 15 20 180 45 375
33364 45 15 20 180 45 375
33365 50 15 20 180 45 380
33366 50 15 20 195 45 395
33367 0 0 0 90 0 90
33368 0 0 0 120 0 120
33369 0 0 0 160 0 160
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
33390 60 15 20 180 45 622
33391 60 15 20 210 45 676
33400 60 15 20 211 40 742
33401 120 0 0 180 420 1028
33403 120 0 0 180 480 1088
33404 46 42 25 238 62 846
33405 60 15 20 197 40 768
33406 60 15 20 282 40 853
33410 60 15 20 229 40 800
33411 60 15 20 283 40 1059
33412 40 3 20 300 60 866
33413 60 15 20 297 40 898
33414 60 15 15 240 60 763
33415 60 15 20 186 40 679
33416 60 18 15 205 60 664
33417 120 0 0 240 300 1003
33418 40 3 20 180 33 561
33419 0 0 0 90 0 90
33420 46 31 25 140 51 761
33422 46 31 25 175 52 892
33425 60 15 20 254 40 880
33426 60 15 20 205 40 776
33427 60 15 20 221 40 737
33430 60 15 20 232 40 913
33460 60 15 20 164 40 877
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
33463 60 15 20 231 40 1127
33464 60 15 20 205 40 871
33465 60 15 20 211 40 972
33468 40 3 20 240 60 806
33470 120 0 0 180 46 769
33471 120 0 0 180 21 572
33474 60 15 20 222 40 738
33475 60 15 20 234 40 750
33476 120 0 0 225 46 859
33477 40 3 20 180 33 276
33478 120 0 0 240 54 882
33496 60 0 0 300 180 881
33500 48 32 25 170 47 690
33501 19 0 0 125 15 411
33502 120 0 0 180 330 973
33503 120 0 0 240 420 1213
33504 120 0 0 240 300 1043
33505 40 12 20 200 40 678
33506 40 12 20 200 40 678
33507 82.5 15 15 180 60 563.5
33508 0 0 0 10 0 10
33510 60 15 20 154 40 718
33511 60 15 20 186 40 750
33512 60 15 20 213 40 832
33513 60 15 20 231 40 850
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
33514 60 15 20 248 40 867
33516 60 15 20 264 40 883
33517 0 0 0 23 0 53.50000086
33518 0 0 0 50 0 112.6000014
33519 0 0 0 70 0 139.7999999
33521 0 0 0 88 0 158.0500008
33522 0 0 0 102 0 174.4500009
33523 0 0 0 110 0 193.0000004
33530 0 0 0 70 0 112.3999992
33533 60 15 20 158 40 682
33534 60 15 20 193 40 717
33535 60 15 20 231 40 755
33536 60 15 20 259 40 783
33542 60 15 20 207 40 848
33545 60 15 20 236 40 939
33548 60 15 20 217 40 928
33572 0 0 0 30 0 30
33600 120 0 0 240 360 958
33602 120 0 0 240 330 928
33606 135 0 0 285 360 1058
33608 120 0 0 300 300 938
33610 120 0 0 240 30 648
33611 45 0 0 240 110 673
33612 45 0 0 240 110 673
33615 45 0 0 250 100 696
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
33617 60 0 0 330 100 811
33619 45 0 0 330 100 1039
33620 40 3 20 120 60 609
33621 40 3 20 95 52.5 363.5
33622 40 3 20 300 60 986
33641 60 15 20 164 40 562
33645 40 3 20 175 45 546
33647 40 3 20 180 53 614
33660 60 15 15 200 60 613
33665 60 15 15 200 60 613
33670 60 15 15 230 60 626
33675 70 15 15 180 60 628
33676 70 15 15 210 60 658
33677 70 15 15 240 60 688
33681 52.5 0 0 150 60 506.5
33684 63 15 15 200 60 616
33688 60 15 15 235 40 628
33690 120 0 0 120 300 883
33692 40 3 20 218 60 684
33694 45 0 0 285 110 718
33697 45 0 0 260 110 693
33702 120 0 0 210 270 956
33710 40 3 20 200 60 656
33720 120 0 0 210 59 770
33722 120 0 0 240 330 908
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
33724 60 15 20 183 53 559
33726 60 15 20 240 60 643
33730 45 0 0 225 100 671
33732 120 0 0 210 300 848
33735 120 0 0 180 360 1073
33736 120 0 0 180 330 848
33737 120 0 0 180 55 706
33750 120 0 0 180 300 968
33755 120 0 0 180 57 750
33762 120 0 0 180 62 755
33764 120 0 0 180 330 1023
33766 120 0 0 180 63 756
33767 120 0 0 240 360 938
33768 0 0 0 30 0 30
33770 60 15 15 240 60 696
33771 60 15 15 260 60 716
33774 120 0 0 240 390 1348
33775 120 0 0 300 40 1043
33776 120 0 0 300 43 1096
33777 120 0 0 300 40 993
33778 37.5 0 0 300 100 838.5
33779 60 15 15 280 40 733
33780 60 15 15 260 50 731
33781 60 12 15 280 40 738
33782 40 3 20 300 60 866
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
33783 40 3 20 360 60 926
33786 45 0 0 285 87.5 838.5
33788 120 0 0 240 330 1033
33800 30 0 0 130 54 375
33802 105 0 0 150 240 751
33803 105 0 0 180 270 811
33813 120 0 0 180 33 664
33814 120 0 0 210 40 838
33820 90 0 0 120 180 558
33822 90 0 0 120 35 463
33824 105 0 0 180 240 811
33840 105 0 0 180 240 831
33845 120 0 0 210 300 978
33851 120 0 0 180 240 891
33852 120 0 0 210 270 951
33853 120 0 0 240 360 998
33860 45 15 20 305 40 931
33863 60 15 20 287 40 905
33864 85 15 20 300 60 853
33870 60 0 0 330 70 770
33875 50 30 20 240 60 993
33877 50 45 15 324 60 1110
33880 90 20 20 225 45 599
33881 75 20 20 200 40 554
33883 70 20 20 120 30 404
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
33884 0 0 0 60 0 60
33886 65 20 20 100 30 379
33889 68 20 20 150 40 298
33891 70 20 20 173 40 323
33910 40 3 20 190 60 889
33915 38 27 25 144 46 858
33916 40 3 20 360 60 1259
33917 120 0 0 240 300 878
33920 120 0 0 270 330 958
33922 120 0 0 195 240 756
33924 0 0 0 30 0 30
33925 90 15 30 180 60 641
33926 90 20 30 240 60 846
33930 202 0 0 180 120 502
33933 0 0 0 0 0 0
33935 80 20 60 380 90 1713
33940 180 0 0 180 90 450
33944 0 0 0 0 0 0
33945 167 15 90 325 85 1716
33946 40 0 0 73 20 133
33947 40 0 0 75 20 135
33948 20 0 0 40 20 80
33949 20 0 0 40 20 80
33951 30 15 15 60 30 170
33952 30 3 15 60 30 158
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
33953 30 15 15 60 30 190
33954 30 3 15 60 30 178
33955 30 15 15 90 30 250
33956 30 15 15 90 30 250
33957 30 15 15 30 20 130
33958 30 3 15 30 20 118
33959 30 15 15 30 20 130
33962 30 3 15 30 20 118
33963 30 15 15 48 20 183
33964 30 15 15 60 20 195
33965 30 15 15 30 20 130
33966 30 3 15 45 20 133
33967 29 0 15 41 33 118
33968 20 0 0 50 20 90
33969 30 15 15 43 20 163
33970 26 23 25 39 23 136
33971 18 10 25 65 28 494
33973 60 0 0 75 210 345
33974 60 0 0 120 180 464
33975 60 15 20 180 120 395
33976 60 15 20 240 120 455
33977 60 15 20 180 60 335
33978 60 15 20 200 60 355
33979 60 15 20 280 120 495
33980 60 15 20 300 90 485
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
33981 60 15 20 120 60 275
33982 60 15 20 290 90 475
33983 60 15 20 345 120 560
33984 30 3 15 45 20 153
33985 30 15 15 55 30 200
33986 30 15 15 60 30 205
33987 0 0 0 45 0 45
33988 30 15 15 90 30 250
33989 30 15 15 60 30 205
33990 29 1 5 60 40 135
33991 44 1 5 90 45 185
33992 14 1 5 45 30 95
33993 14 1 5 30 30 80
33999 0 0 0 0 0 0
34001 30 15 15 90 30 384
34051 35 23 25 139 39 594
34101 75 0 0 60 30 322
34111 60 0 0 60 30 307
34151 75 0 0 150 30 508
34201 30 15 15 128 30 422
34203 75 0 0 108 30 413
34401 70 0 0 150 30 503
34421 70 0 0 95 30 412
34451 70 0 0 180 30 533
34471 30 15 15 180 20 453
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
34490 80 0 0 80 30 367
34501 90 0 0 120 30 393
34502 150 0 0 300 240 951
34510 95 0 0 150 30 448
34520 90 0 0 143 30 443
34530 90 0 0 120 30 436
34800 130 0 0 120 40 427
34802 135 0 0 150 40 462
34803 75 15 20 165 30 442
34804 120 0 0 150 35 442
34805 65 15 25 150 30 422
34806 10 0 0 25 0 35
34808 0 0 0 60 0 60
34812 75 0 0 45 30 150
34813 0 0 0 60 0 60
34820 80 0 0 75 30 185
34825 80 0 0 60 30 307
34826 0 0 0 30 0 30
34830 60 0 0 210 45 665
34831 60 0 0 240 40 690
34832 60 0 0 240 60 710
34833 75 0 0 100 27 221
34834 70 0 0 30 35 154
34841 0 0 0 0 0 0
34842 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
34843 0 0 0 0 0 0
34844 0 0 0 0 0 0
34845 0 0 0 0 0 0
34846 0 0 0 0 0 0
34847 0 0 0 0 0 0
34848 0 0 0 0 0 0
34900 105 0 0 120 30 352
35001 39 15 25 186 39 568
35002 41 15 25 198 39 592
35005 38 14 25 173 37 551
35011 90 0 0 120 30 357
35013 90 0 0 133 30 433
35021 38 27 25 170 42 745
35022 40 29 25 183 44 764
35045 90 0 0 120 30 329
35081 60 15 15 210 30 677
35082 60 0 0 180 60 792
35091 93 0 0 249 255 995
35092 60 0 0 260 60 1172
35102 60 15 15 265 30 732
35103 60 0 0 180 60 740
35111 90 0 0 150 30 483
35112 90 0 0 180 60 690
35121 90 0 0 190 30 563
35122 90 0 0 220 60 770
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
35131 105 0 0 150 40 528
35132 55 0 0 180 60 655
35141 90 0 0 150 30 427
35142 90 0 0 150 45 555
35151 100 0 0 150 30 473
35152 90 0 0 180 45 590
35180 32 12 25 99 36 500
35182 88 0 0 200 30 553
35184 88 0 0 150 30 413
35188 40 3 20 150 30 380
35189 88 0 0 165 30 548
35190 45 11 25 124 35 416
35201 29 9 25 93 30 382
35206 50 0 0 90 25 282
35207 28 9 25 88 30 376
35211 41 30 25 235 42 806
35216 30 15 15 180 60 658
35221 53 0 0 125 45 545
35226 60 0 0 100 30 327
35231 60 0 0 120 30 382
35236 60 0 0 120 30 367
35241 41 29 25 227 42 797
35246 90 0 0 180 45 577
35251 70 0 0 180 30 532
35256 60 0 0 120 30 347
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
35261 60 0 0 120 30 382
35266 60 0 0 90 30 337
35271 40 28 25 210 42 778
35276 90 0 0 180 45 553.5
35281 85 0 0 180 40 595
35286 60 0 0 100 30 350
35301 40 15 20 120 30 404
35302 40 15 20 150 30 392
35303 40 15 20 150 30 392
35304 40 15 20 180 30 422
35305 40 15 20 160 30 402
35306 0 0 0 90 0 90
35311 90 0 0 180 30 532
35321 90 0 0 100 30 337
35331 95 0 0 180 30 558
35341 39 14 25 179 38 549
35351 90 0 0 150 30 502
35355 90 0 0 120 30 457
35361 90 0 0 210 30 605
35363 90 0 0 240 30 655
35371 75 0 0 103 30 325
35372 80 0 0 120 30 347
35390 0 0 0 180 0 180
35400 0 0 0 45 0 45
35450 27 9 25 72 30 163
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
35452 28 9 25 72 32 166
35458 27 9 25 63 32 156
35460 30 15 20 60 35 160
35471 0 0 0 90 140 230
35472 0 0 0 85 93 178
35475 12 4 5 43 23 87
35476 12 4 5 35 20 76
35500 0 0 0 60 0 60
35501 40 15 20 200 30 449
35506 30 15 15 165 28 452
35508 30 15 15 170 30 404
35509 40 15 20 190 30 439
35510 65 10 28 180 30 497
35511 75 0 0 150 25 407
35512 30 10 28 180 30 462
35515 30 15 15 180 30 414
35516 30 15 15 180 20 424
35518 75 0 0 140 25 457
35521 90 0 0 155 30 530
35522 65 10 28 180 30 497
35523 45 10 20 180 30 485
35525 53 10 28 150 30 415
35526 90 0 0 210 30 562
35531 90 0 0 240 30 740
35533 90 0 0 240 30 615
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
35535 40 15 20 240 30 690
35536 70 0 0 180 25 550
35537 50 15 20 288 40 683
35538 50 15 20 360 43 798
35539 60 20 20 300 30 720
35540 60 20 20 360 30 780
35556 30 25 15 251 30 586
35558 70 0 0 180 25 530
35560 90 0 0 200 25 590
35563 75 0 0 180 25 535
35565 75 0 0 180 25 535
35566 30 25 15 306 30 718
35570 40 15 20 240 30 667
35571 80 0 0 180 30 510
35572 0 0 0 60 0 60
35583 30 25 15 253 30 588
35585 30 25 15 305 30 717
35587 93 0 0 180 30 523
35600 0 0 0 40 0 40
35601 40 15 20 180 30 484
35606 30 15 15 145 30 414
35612 40 5 20 180 40 485
35616 30 15 15 140 30 367
35621 85 0 0 120 30 412
35623 75 0 0 120 25 475
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
35626 98 0 0 180 30 520
35631 110 0 0 225 38 648
35632 40 15 20 240 30 690
35633 40 15 20 240 30 705
35634 40 15 20 230 30 680
35636 78 0 0 200 30 603
35637 40 15 20 210 30 605
35638 40 15 20 240 30 635
35642 35 13 25 127 37 463
35645 35 13 25 127 37 463
35646 100 0 0 210 30 645
35647 100 0 0 170 30 573
35650 75 0 0 110 25 382
35654 90 0 0 180 30 513
35656 90 0 0 150 30 447
35661 90 0 0 120 30 440
35663 75 0 0 148 25 503
35665 100 0 0 150 30 480
35666 90 0 0 150 30 490
35671 70 0 0 135 30 435
35681 0 0 0 184 0 184
35682 0 0 0 78 0 78
35683 0 0 0 90 0 90
35685 0 0 0 45 0 45
35686 0 0 0 35 0 35
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
35691 90 0 0 160 41 417
35693 70 0 0 140 36 372
35694 120 0 0 180 120 546
35695 120 0 0 180 46 532
35697 0 0 0 30 0 30
35700 0 0 0 300 0 300
35701 55 0 0 60 30 262
35721 53 0 0 60 30 273
35741 50 0 0 75 30 272
35761 26 8 25 75 27 317
35800 30 3 5 60 30 336
35820 30 10 5 136 40 799
35840 30 3 5 60 30 431
35860 30 3 5 60 30 376
35870 38 14 25 182 37 715
35875 60 0 0 90 30 297
35876 60 0 0 155 30 402
35879 75 0 0 120 25 421
35881 75 0 0 150 25 450
35883 50 15 20 170 30 462
35884 50 15 20 190 30 482
35901 120 0 0 150 150 602
35903 90 0 0 150 120 506
35905 120 0 0 240 45 720
35907 120 0 0 240 45 720
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
36000 0 0 0 10 0 10
36002 35 0 0 30 15 80
36005 5 5 5 5 5 25
36010 0 0 0 26 0 26
36011 0 0 0 35 0 35
36012 0 0 0 39 0 39
36013 0 0 0 28 0 28
36014 0 0 0 34 0 34
36015 0 0 0 39 0 39
36100 0 0 0 20 0 20
36120 0 0 0 22 0 22
36140 0 0 0 25 0 25
36147 10 0 0 45 15 70
36148 0 0 0 15 0 15
36160 0 0 0 29 0 29
36200 23 3 5 30 20 81
36215 0 0 0 61 0 61
36216 0 0 0 72 0 72
36217 0 0 0 86 0 86
36218 0 0 0 14 0 14
36221 30 3 5 30 30 98
36222 30 3 5 40 30 108
36223 30 3 5 45 30 113
36224 30 3 5 50 30 118
36225 30 3 5 45 30 113
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
36226 30 3 5 50 30 118
36227 0 0 0 15 0 15
36228 0 0 0 30 0 30
36245 23 3 5 45 20 96
36246 23 3 5 45 20 96
36247 23 3 5 60 30 121
36248 0 0 0 14 0 14
36251 23 3 5 45 30 106
36252 23 3 5 53 30 114
36253 23 3 5 60 30 121
36254 23 3 5 68 30 129
36260 34 6 25 96 30 287
36261 25 0 25 75 20 233
36262 20 0 25 49 17 181
36299 0 0 0 0 0 0
36400 5 0 0 10 5 20
36405 4 0 0 10 4 18
36406 0 0 0 10 0 10
36410 1 0 0 5 2 8
36415 0 0 0 0 0 0
36416 0 0 0 0 0 0
36420 0 0 0 29 0 29
36425 0 0 0 22 0 22
36430 0 0 0 0 0 0
36440 10 15 10 35
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
36450 30 120 30 180
36455 30 60 30 120
36456 15 30 15 60
36460 60 0 0 60 60 180
36468 0 0 0 0 0 0
36470 10 0 0 15 5 46
36471 16 0 0 30 10 72
36473 17 4 10 30 15 76
36474 30 30
36475 20 4 10 45 15 94
36476 0 0 0 30 0 30
36478 20 4 10 45 15 94
36479 0 0 0 30 0 30
36481 0 0 0 75 77 152
36500 13 0 0 32 11 56
36510 12 0 0 20 10 42
36511 40 0 0 20 15 75
36512 40 0 0 20 15 75
36513 40 0 0 20 15 75
36514 40 0 0 20 15 75
36515 40 0 0 20 15 75
36516 25 0 0 15 10 50
36522 16 0 0 60 11 87
36555 10 5 5 20 10 50
36556 15 5 5 15 10 50
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
36557 20 7 10 30 15 117
36558 15 6 10 30 15 111
36560 20 9 10 45 15 134
36561 10 5 10 45 15 120
36563 10 10 10 60 15 140
36565 10 5 10 45 15 120
36566 10 5 10 60 15 135
36568 15 5 5 20 10 55
36569 15 5 5 20 10 55
36570 20 10 10 45 15 135
36571 10 10 10 50 15 130
36575 10 0 5 15 9 39
36576 15 6 10 33 15 114
36578 10 6 10 30 15 106
36580 15 5 5 15 10 50
36581 15 5 10 30 15 110
36582 20 6 10 60 15 146
36583 20 7 10 60 15 147
36584 15 0 5 15 10 45
36585 1 10 10 60 15 131
36589 12 5 8 13 15 79
36590 10 5 10 30 15 105
36591 0 0 0 0 0 0
36592 0 0 0 0 0 0
36593 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
36595 30 0 0 45 15 90
36596 23 0 0 9 5 37
36597 15 0 0 20 10 45
36598 5 5 5 10 10 35
36600 3 0 0 10 3 16
36620 2 2 3 10 5 22
36625 11 0 0 29 7 47
36640 11 0 0 30 7 48
36660 11 0 0 28 7 46
36680 10 0 15 13 10 48
36800 8 0 25 35 8 76
36810 16 0 25 78 12 131
36815 16 0 25 72 12 125
36818 50 10 15 90 25 248
36819 50 10 15 120 30 283
36820 50 10 15 100 25 258
36821 50 10 15 75 25 233
36823 75 0 0 230 30 606
36825 50 10 15 120 30 306
36830 50 10 15 90 25 248
36831 50 10 15 85 30 248
36832 50 10 15 90 30 276
36833 50 10 15 120 30 306
36835 23 6 25 45 25 242
36838 65 15 20 150 30 424
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
36860 12 0 0 48 12 72
36861 12 0 0 30 12 54
36870 10 0 0 60 15 120
36901 17 4 5 25 15 66
36902 17 4 5 40 20 86
36903 17 4 5 50 20 96
36904 22 4 5 60 20 111
36905 22 4 5 75 20 126
36906 22 4 5 90 20 141
36907 25 25
36908 40 40
36909 30 30
37140 40 3 20 240 60 845
37145 40 3 20 233 60 798
37160 40 3 20 220 60 785
37180 40 3 20 240 60 805
37181 40 3 20 270 60 785
37182 30 0 0 150 30 210
37183 17.5 0 0 77.5 30 125
37184 10 10 10 90 30 150
37185 0 0 0 40 0 40
37186 0 0 0 60 0 60
37187 16 5 9 85 20 135
37188 8 7 10 58 20 103
37191 20 3 5 30 15 73
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
37192 23 3 5 45 15 91
37193 23 3 5 45 15 91
37195 0 0 0 0 0 0
37197 23 3 5 60 20 111
37200 30 15 20 42 35 142
37211 30 3 5 60 30 128
37212 30 3 5 60 30 128
37213 23 3 5 33 25 89
37214 23 3 5 38 23 92
37215 50 15 15 103 30 337
37216 60 15 15 97 30 341
37217 40 14 20 120 30 403
37218 23 5 5 90 28 255
37220 30 3 5 60 30 128
37221 30 3 5 90 30 158
37222 1 0 0 40 1 42
37223 1 0 0 45 1 47
37224 30 3 5 80 30 148
37225 30 3 5 118 30 186
37226 30 3 5 90 30 158
37227 30 3 5 125 30 193
37228 30 3 5 90 30 158
37229 30 3 5 120 30 188
37230 30 3 5 120 30 188
37231 30 3 5 135 30 203
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
37232 1 0 0 40 1 42
37233 1 0 0 60 1 62
37234 1 0 0 60 1 62
37235 1 0 0 80 1 82
37236 23 3 5 90 30 151
37237 1 0 0 45 1 47
37238 23 3 5 60 30 121
37239 1 0 0 30 1 32
37241 14 3 5 90 30 142
37242 23 3 5 100 30 161
37243 23 3 5 120 45 196
37244 23 3 5 90 45 166
37246 23 3 5 60 28 119
37247 30 30
37248 23 3 5 60 28 119
37249 30 30
37252 1 0 0 20 1 22
37253 0 0 0 20 1 21
37500 60 0 0 90 30 261
37501 0 0 0 0 0 0
37565 55 0 0 60 25 312
37600 55 0 0 70 25 322
37605 55 0 0 90 25 342
37606 28 9 25 84 29 606
37607 60 0 0 90 60 242
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
37609 45 0 0 30 20 130
37615 22 6 25 54 24 489
37616 33 23 25 107 40 656
37617 58 0 0 120 45 475
37618 22 6 25 49 24 359
37619 40 3 15 150 60 683
37650 60 0 0 60 25 262
37660 60 0 0 120 25 397
37700 19 0 25 41 16 152
37718 35 10 10 45 20 178
37722 40 10 10 60 20 198
37735 35 10 25 139 30 365
37760 30 25 8 133 23 335
37761 33 10 15 60 25 224
37765 33 10 15 60 25 201
37766 33 10 15 90 25 231
37780 20 0 25 47 17 179
37785 21 25 0 63 17 177
37788 60 0 0 240 90 627
37790 45 0 0 120 60 257
37799 0 0 0 0 0 0
38100 30 15 15 120 30 442
38101 30 15 15 120 30 442
38102 0 0 0 60 0 60
38115 30 15 15 120 40 492
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
38120 60 0 0 180 30 434
38129 0 0 0 0 0 0
38200 18 0 0 27 16 61
38204 0 0 0 0 0 72.5
38205 38 0 0 45 30 113
38206 40 0 0 35 20 95
38207 5 0 0 30 10 45
38208 5 0 0 45 10 60
38209 5 0 0 37.5 10 52.5
38210 5 0 0 60 10 75
38211 0 0 0 25 0 25
38212 5 0 0 12.5 15 32.5
38213 5 0 0 30 10 45
38214 5 0 0 30 10 45
38215 5 0 0 40 10 55
38220 0 0 0 0 0 34
38221 0 0 0 0 0 43
38230 20 15 20 90 30 175
38232 15 15 15 90 30 165
38240 30 0 0 60 30 120
38241 18 0 0 60 30 108
38242 30 0 0 45 30 105
38243 30 0 0 45 30 105
38300 45 0 0 20 30 134
38305 45 0 0 30 30 186
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
38308 45 0 0 45 30 178
38380 21 0 25 63 19 350
38381 30 17 25 105 31 348
38382 25 0 25 93 22 335
38500 35 0 0 30 15 115
38505 11 0 0 28 11 50
38510 45 0 0 45 20 152
38520 45 0 0 60 30 193
38525 45 0 0 45 30 178
38530 45 0 0 72.5 30 205.5
38542 33 10 15 60 15 198
38550 23 0 15 69 21 211
38555 30 0 25 156 24 536
38562 25 0 25 82 24 326
38564 34 0 25 110 24 349
38570 40 3 10 60 30 220
38571 40 3 10 90 30 250
38572 40 15 15 120 30 321
38589 0 0 0 0 0 0
38700 30 15 15 90 30 300
38720 45 15 15 150 30 482
38724 45 15 15 180 30 512
38740 60 0 0 60 30 231
38745 57.5 0 0 90 25 270.5
38746 0 0 0 30 0 30
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
38747 0 0 0 60 0 60
38760 60 0 0 70 30 241
38765 60 0 0 120 30 465
38770 35 0 25 123 22 403
38780 48 0 25 190 28 551
38790 11 0 0 22 11 44
38792 15 0 0 10 10 35
38794 19 0 25 55 14 207
38900 2 0 0 45 0 47
38999 0 0 0 0 0 0
39000 26 19 25 61 28 381.5
39010 20 17 25 115 34 423.5
39200 44 28 25 91 30 459
39220 60 15 20 124 40 436
39401 33 5 10 45 30 142
39402 33 5 10 60 30 157
39499 0 0 0 0 0 0
39501 33 0 25 98 26 378
39503 150 0 0 120 60 2138
39540 34 22 25 121 38 490
39541 35 23 25 133 38 522
39545 35 0 25 113 27 466
39560 15 0 0 90 30 323
39561 25 0 0 150 30 505
39599 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
40490 8 1 5 15 5 34
40500 27 0 15 78 22 206
40510 21 0 15 57 20 153
40520 21 0 15 56 19 151
40525 28 0 15 128 24 270
40527 31 0 15 143 25 316
40530 23 0 15 66 20 191
40650 18 0 15 26 19 126
40652 19 0 15 44 20 154
40654 23 0 15 66 23 183
40700 36 0 0 121 30 337
40701 36 0 0 164 30 380
40702 36 0 0 135 39 348.5
40720 55 0 0 135 39 357.5
40761 34 0 25 163 28 387
40799 0 0 0 0 0 0
40800 15 0 0 15 10 63
40801 15 0 0 25 15 87
40804 20 0 0 20 15 78
40805 20 0 0 30 15 97
40806 15 0 0 15 10 40
40808 15 0 0 15 10 56
40810 15 0 0 15 10 56
40812 15 0 0 20 10 68
40814 15 0 0 30 12 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
40816 20 0 0 40 15 114
40818 18 0 0 40 10 123
40819 15 0 0 20 10 77
40820 15 0 0 20 10 68
40830 15 0 0 20 10 68
40831 15 0 0 35 10 99
40840 45 0 0 120 45 272
40842 38 0 0 120 30 250
40843 45 0 0 180 60 370
40844 60 0 0 180 60 417
40845 60 0 0 160 60 397
40899 0 0 0 0 0 0
41000 9 0 0 16 10 51
41005 10 0 0 17 10 53
41006 16 0 0 21 16 104
41007 16 0 0 24 15 106
41008 17 0 0 25 16 109
41009 17 0 0 26 17 119
41010 8 0 0 7 9 40
41015 19 0 0 36 17 131
41016 18 0 25 31 17 169
41017 19 0 25 36 18 176
41018 20 0 25 38 18 179
41019 30 10 15 90 30 175
41100 10 10 5 15 10 66
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
41105 11 0 0 13 11 51
41108 8 0 0 10 8 42
41110 10 0 0 20 10 56
41112 15 0 0 31 15 93
41113 17 0 0 39 16 104
41114 23 0 25 77 26 275
41115 9 0 0 13 10 48
41116 14 0 0 22 14 74
41120 30 15 15 60 30 278
41130 45 15 20 90 30 407
41135 60 15 20 210 30 696
41140 60 15 20 155 40 728
41145 60 15 20 300 40 913
41150 60 15 20 180 40 713
41153 60 15 20 270 40 826
41155 60 15 20 320 40 968
41250 13 0 0 27 13 69
41251 15 0 0 34 15 80
41252 18 0 0 40 17 91
41500 17 0 0 38 16 122
41510 17 0 0 32 16 97
41512 15 15 15 60 30 209
41520 15 0 0 28 15 90
41530 40 5 10 20 20 95
41599 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
41800 10 0 0 12 5 59
41805 10 0 0 8 5 55
41806 10 0 0 33 5 80
41820 0 0 0 0 0 0
41821 0 0 0 0 0 0
41822 18 0 0 47 10 107
41823 18 0 0 44 5 138
41825 10 0 0 10 5 57
41826 10 0 0 26 5 73
41827 18 0 0 58 10 141
41828 30 0 0 53 30 129
41830 30 0 0 60 25 154
41850 0 0 0 0 0 0
41870 0 0 0 0 0 0
41872 13 0 0 44 10 122
41874 30 0 0 60 30 152
41899 0 0 0 0 0 0
42000 10 0 0 13 10 49
42100 8 0 0 10 8 42
42104 10 0 0 15 11 52
42106 14 0 0 24 14 68
42107 19 0 0 61 21 160
42120 30 15 15 80 30 306
42140 14 0 15 18 13 84
42145 40 10 15 60 30 262
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
42160 11 0 0 16 11 54
42180 14 0 0 21 14 65
42182 16 0 15 28 15 90
42200 60 0 0 120 30 330
42205 25 0 25 89 23 288
42210 60 0 0 180 30 390
42215 28 0 25 94 24 265
42220 27 0 25 99 23 260
42225 29 0 25 105 24 287
42226 29 0 25 115 23 316
42227 23 0 25 94 23 291
42235 27 0 15 97 23 248
42260 60 0 0 90 30 280
42280 10 0 0 17 10 53
42281 9 0 15 15 9 83
42299 0 0 0 0 0 0
42300 14 0 0 23 13 66
42305 19 0 25 43 18 203
42310 12 0 0 17 12 57
42320 15 0 0 32 14 77
42330 12 0 0 26 9 63
42335 18 0 0 31 17 98
42340 22 0 0 53 21 136
42400 8 0 0 11 9 28
42405 15 0 15 35 14 95
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
42408 22 0 0 52 20 134
42409 16 0 0 24 15 87
42410 29 0 25 103 24 285
42415 40 12 20 150 30 333
42420 40 12 20 180 50 383
42425 32 0 25 132 25 348
42426 34 0 25 278 25 654
42440 30 10 15 60 25 198
42450 22 0 0 55 19 155
42500 21 0 0 50 18 148
42505 24 0 25 71 20 207
42507 26 0 15 78 24 191
42509 32 0 25 162 26 349
42510 27 0 25 100 22 270
42550 10 0 0 16 10 36
42600 22 0 0 62 20 163
42650 6 0 0 14 6 26
42660 11 0 0 20 11 42
42665 16 0 0 29 15 92
42699 0 0 0 0 0 0
42700 11 0 0 15 11 53
42720 60 0 0 30 30 278
42725 60 0 0 60 30 390
42800 10 0 0 10 9 45
42804 9 0 0 15 9 49
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
42806 11 0 15 22 10 74
42808 13 0 15 31 12 87
42809 12 0 15 17 12 72
42810 18 0 15 36 17 126
42815 20 0 25 78 19 240
42820 30 0 0 30 30 151
42821 0 23 0 35 40 141
42825 16 0 25 23 15 130
42826 20 0 15 28 18 124
42830 19 0 25 17 18 103
42831 14 0 15 19 13 93
42835 13 0 15 16 13 81
42836 14 0 15 18 13 84
42842 30 15 15 80 30 330
42844 45 15 15 120 30 445
42845 60 15 20 240 40 825
42860 14 0 0 20 18 76
42870 22 0 15 51 20 167
42890 45 15 20 120 30 510
42892 45 15 20 170 35 643
42894 60 15 20 240 40 836
42900 24 0 15 50 20 163
42950 29 0 25 122 23 293
42953 34 0 25 171 27 409
42955 20 0 25 52 19 282
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
42960 15 0 0 24 15 70
42961 19 0 25 43 18 193
42962 23 0 25 61 19 234
42970 19 0 0 35 19 193
42971 20 0 25 44 18 227
42972 20 0 25 60 18 243
42999 0 0 0 0 0 0
43020 26 0 15 71 23 221
43030 21 0 25 70 20 244
43045 57 26 25 151 49 536.5
43100 27 0 25 115 23 334
43101 35 22 25 142 37 459
43107 90 0 0 300 45 987
43108 60 15 20 461 40 1358
43112 103 0 0 415 118 1243
43113 60 15 20 391 40 1358
43116 60 15 20 561 40 1403
43117 110 0 0 410 60 1077
43118 60 15 20 327 40 1184
43121 60 15 20 240 40 962
43122 105 0 0 310 48 1015
43123 60 15 20 442 40 1419
43124 60 15 20 243 40 1398
43130 26 0 25 84 25 362
43135 60 15 20 164 40 571
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
43180 40 10 10 60 20 201
43191 35 6 10 20 15 86
43192 40 6 10 23 20 99
43193 40 6 10 30 20 106
43194 33 6 10 30 28 107
43195 33 6 10 30 15 94
43196 33 6 10 33 20 102
43197 17 1 5 15 10 48
43198 17 1 5 20 10 53
43200 14 3 5 15 10 47
43201 14 3 5 15 10 47
43202 14 3 5 15 10 47
43204 15 3 5 20 10 53
43205 15 3 5 20 10 53
43206 14 3 5 30 10 62
43210 33 10 15 60 30 148
43211 23 3 5 45 18 94
43212 23 3 5 30 15 76
43213 23 3 5 45 15 91
43214 23 3 5 30 16 77
43215 15 3 5 20 10 53
43216 15 3 5 22 10 55
43217 15 3 5 30 10 63
43220 14 3 5 20 10 52
43226 14 3 5 25 10 57
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
43227 15 3 5 30 10 63
43229 22 3 5 45 15 90
43231 23 3 5 30 20 81
43232 23 3 5 45 20 96
43233 20 3 5 30 20 78
43235 14 3 5 15 12 49
43236 14 3 5 20 15 57
43237 20 3 5 35 20 83
43238 20 3 5 45 20 93
43239 14 3 5 15 12 49
43240 23 3 5 70 30 131
43241 15 3 5 30 15 68
43242 23 3 5 50 23 104
43243 23 3 5 30 20 81
43244 23 3 5 30 20 81
43245 15 3 5 23 15 61
43246 23 3 5 30 15 76
43247 5 3 5 30 15 58
43248 14 3 5 20 15 57
43249 14 3 5 20 15 57
43250 11 3 5 20 14 53
43251 15 3 5 20 10 53
43252 14 3 5 30 20 72
43253 23 3 5 40 23 94
43254 20 3 5 45 20 93
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
43255 23 3 5 30 20 81
43257 23 3 5 45 15 91
43259 23 3 5 45 20 96
43260 23 10 5 48 25 111
43261 23 10 5 55 23 116
43262 23 10 5 60 30 128
43263 23 10 5 60 30 128
43264 23 10 5 60 28 126
43265 23 10 5 78 28 144
43266 23 3 5 40 20 91
43270 23 3 5 45 15 91
43273 0 0 0 30 0 30
43274 23 10 5 68 23 129
43275 23 10 5 50 20 108
43276 23 10 5 60 25 123
43277 23 10 5 70 25 133
43278 23 10 5 75 30 143
43279 40 20 20 150 30 404
43280 100 0 0 150 30 404
43281 40 15 15 180 30 424
43282 40 15 15 210 30 454
43283 0 0 0 40 0 40
43284 33 15 15 60 30 218
43285 40 15 15 68 30 233
43289 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
43300 31 0 15 138 26 312
43305 32 0 25 125 29 403
43310 39 26 25 191 39 528
43312 42 29 25 240 41 563
43313 128 0 0 178 45 713
43314 128 0 0 178 45 713
43320 90 0 0 180 30 740
43325 90 0 0 150 30 600
43327 40 3 20 120 30 412
43328 40 20 20 150 30 514
43330 90 0 0 120 30 550
43331 90 0 0 120 30 620
43332 40 3 20 150 30 482
43333 40 3 20 180 30 512
43334 40 20 20 180 30 549
43335 40 20 20 200 30 569
43336 40 20 20 240 30 695
43337 40 20 20 260 30 715
43338 0 0 0 30 0 30
43340 90 0 0 180 60 770
43341 90 0 0 180 60 770
43351 90 0 0 165 60 778
43352 90 0 0 90 60 570
43360 90 0 0 270 40 830
43361 90 0 0 300 60 1108
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
43400 90 0 0 120 45 835
43401 90 0 0 150 45 865
43405 90 0 0 135 45 873
43410 90 0 0 90 30 590
43415 40 20 20 180 60 842
43420 90 0 0 90 30 520
43425 90 0 0 180 45 845
43450 14 3 5 15 14 51
43453 14 3 5 20 15 57
43460 21 0 15 35 23 94
43496 90 0 0 410 60 902
43499 0 0 0 0 0 0
43500 60 0 0 60 30 402
43501 60 0 0 120 30 555
43502 60 0 0 120 30 555
43510 60 0 0 120 30 485
43520 60 0 0 60 30 342
43605 60 0 0 60 30 402
43610 60 0 0 90 30 432
43611 60 0 0 100 30 520
43620 30 15 15 200 30 695
43621 30 15 15 240 30 790
43622 30 15 15 240 30 790
43631 75 0 0 150 30 535
43632 30 15 15 225 30 725
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
43633 30 15 15 240 30 740
43634 30 15 15 240 30 740
43635 39 0 25 162 29 255
43640 60 0 0 120 30 540
43641 60 0 0 150 30 570
43644 30 30 15 180 30 502
43645 45 30 15 200 30 537
43647 0 0 0 0 0 0
43648 0 0 0 0 0 0
43651 60 0 0 120 52 232
43652 60 0 0 165 60 285
43653 60 0 0 70 30 264
43659 0 0 0 0 0 0
43752 5 0 0 20 5 30
43753 0 3 3 10 5 21
43754 5 0 0 10 5 20
43755 7 0 0 25 5 37
43756 5 0 0 15 5 25
43757 7 0 0 40 5 52
43760 10 5 2 10 5 32
43761 10 10 20 35 10 85
43770 60 25 15 90 30 367
43771 45 25 10 120 30 377
43772 45 25 10 90 30 317
43773 45 25 10 120 30 377
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
43774 45 25 15 90 25 304
43775 40 25 20 120 30 412
43800 60 0 0 90 30 432
43810 60 0 0 105 30 502
43820 30 15 15 120 30 545
43825 60 0 0 120 30 540
43830 50 0 0 60 25 319
43831 26 0 25 48 20 293
43832 60 0 0 75 30 417
43840 30 15 15 90 30 565
43842 60 0 0 150 30 585
43843 60 0 0 150 30 585
43845 60 20 15 210 30 628
43846 60 0 0 180 30 693
43847 60 0 0 220 30 733
43848 75 0 0 180 30 708
43850 75 0 0 150 30 625
43855 75 0 0 175 30 610
43860 75 0 0 180 30 675
43865 75 0 0 180 30 615
43870 60 0 0 60 30 402
43880 60 0 0 120 30 540
43881 0 0 0 0 0 0
43882 0 0 0 0 0 0
43886 20 15 10 30 15 155
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
43887 20 15 10 30 15 148
43888 30 15 10 45 15 180
43999 0 0 0 0 0 0
44005 60 0 0 120 30 517
44010 60 0 0 90 30 432
44015 0 0 0 24 0 24
44020 60 0 0 90 30 487
44021 60 0 0 90 30 487
44025 60 0 0 90 30 487
44050 60 0 0 82.5 30 409.5
44055 84 0 0 90 30 663
44100 17 0 15 55 14 101
44110 60 0 0 90 30 487
44111 60 0 0 120 30 517
44120 30 15 15 134 30 611
44121 0 0 0 60 0 60
44125 60 0 0 120 30 524
44126 90 0 0 120 30 1125
44127 90 0 0 150 30 1357
44128 0 0 0 40 0 40
44130 30 15 15 131 30 516
44132 0 0 0 0 0 0
44133 0 0 0 0 0 0
44135 0 0 0 0 0 0
44136 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
44137 0 0 0 0 0 0
44139 0 0 0 30 0 30
44140 30 15 15 150 30 480
44141 45 20 15 160 45 672
44143 30 15 15 150 30 607
44144 45 20 15 165 45 677
44145 60 20 15 180 45 615
44146 60 20 15 240 45 692
44147 60 20 15 220 45 710
44150 30 15 15 180 30 638
44151 30 15 15 240 30 738
44155 30 15 15 240 30 738
44156 30 15 15 300 30 798
44157 30 15 15 240 45 705
44158 30 15 15 260 45 725
44160 63 0 0 120 45 551
44180 100 0 0 120 30 407
44186 60 0 0 75 15 267
44187 45 25 10 75 30 385
44188 45 25 10 90 30 407
44202 75 0 0 200 30 505
44203 0 0 0 60 0 60
44204 45 0 0 180 30 455
44205 47.5 0 0 165 30 428.5
44206 70 0 0 180 35 647
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
44207 75 0 0 195 35 560
44208 75 0 0 205 35 595
44210 75 0 0 240 35 630
44211 80 0 0 300 35 695
44212 75 0 0 270 35 660
44213 0 0 0 45 0 45
44227 45 25 10 150 30 530
44238 0 0 0 0 0 0
44300 75 0 0 60 30 389
44310 75 0 0 62.5 30 391.5
44312 75 0 0 60 30 349
44314 75 0 0 120 30 465
44316 75 0 0 150 30 590
44320 75 0 0 90 30 507
44322 33 0 25 92 27 483
44340 75 0 0 60 30 382
44345 75 0 0 120 30 482
44346 75 0 0 120 30 572
44360 11 0 15 45 17 88
44361 11 0 15 36 19 81
44363 6 0 25 47 19 97
44364 7 0 25 47 21 100
44365 17 0 0 48 16 81
44366 9 0 25 48 23 105
44369 9 0 25 51 22 107
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
44370 21 0 0 70 22 113
44372 11 0 25 40 22 98
44373 11 0 25 46 22 104
44376 25 0 0 180 17 222
44377 25 0 0 180 17 222
44378 20 0 0 180 17 217
44379 20 0 0 205 22 247
44380 6 0 25 22 13 66
44381 15 1 5 25 15 61
44382 14 1 5 20 12 52
44384 23 1 5 40 15 84
44385 14 3 5 15 10 47
44386 14 3 5 17 10 49
44388 14 2 5 25 14 60
44389 14 2 5 30 14 65
44390 20 2 5 35 15 77
44391 23 2 5 40 15 85
44392 14 2 5 30 10 61
44394 10 2 5 30 10 57
44401 15 2 5 30 10 62
44402 23 2 5 43 15 88
44403 15 2 5 45 15 82
44404 14 2 5 30 10 61
44405 15 2 5 38 12 72
44406 23 2 5 40 20 90
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
44407 23 2 5 60 20 110
44408 23 2 5 40 15 85
44500 1 0 0 25 5 31
44602 30 15 15 90 30 562
44603 30 15 15 120 30 635
44604 60 0 0 90 30 459
44605 60 0 0 125 30 562
44615 60 0 0 105 30 502
44620 60 0 0 90 30 487
44625 60 0 0 120 30 517
44626 60 0 0 150 30 587
44640 60 0 0 150 30 587
44650 60 0 0 150 30 587
44660 60 0 0 150 30 587
44661 60 0 0 180 30 617
44680 60 0 0 165 30 602
44700 60 0 0 95 30 402
44701 0 0 0 35 0 35
44705 0 0 0 0 0 0
44715 0 0 0 0 0 0
44720 0 0 0 50 0 50
44721 0 0 0 70 0 70
44799 0 0 0 0 0 0
44800 32 0 25 80 25 366
44820 60 0 0 90 30 404
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
44850 60 0 0 60 30 367
44899 0 0 0 0 0 0
44900 50 0 0 60 30 450
44950 50 0 0 60 25 252
44955 0 0 0 20 0 20
44960 50 0 0 75 30 458
44970 45 0 0 73 20 242
44979 0 0 0 0 0 0
45000 90 0 0 45 30 384
45005 14 0 0 19 13 54
45020 30 15 15 45 30 255
45100 60 0 0 30 30 178
45108 60 0 0 45 30 193
45110 80 0 0 180 30 678
45111 36 0 25 93 30 496
45112 80 0 0 200 45 675
45113 80 0 0 200 45 675
45114 80 0 0 210 45 792
45116 80 0 0 160 45 702
45119 80 0 0 210 45 685
45120 48 0 25 214 34 689
45121 48 0 25 226 34 741
45123 80 0 0 270 45 687
45126 80 0 0 120 45 755
45130 80 0 0 120 45 520
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
45135 80 0 0 220 45 735
45136 40 0 0 240 30 783
45150 22 0 25 30 19 184
45160 80 0 0 60 45 342
45171 33 15 15 45 20 209
45172 40 15 20 75 20 290
45190 80 0 0 60 45 266
45300 2 5 0 10 10 27
45303 5 5 5 15 10 40
45305 10 5 5 10 10 40
45307 5 5 5 15 10 40
45308 5 5 5 15 10 40
45309 5 5 5 15 10 40
45315 5 5 5 20 10 45
45317 5 5 5 20 10 45
45320 5 5 5 23 10 48
45321 0 5 5 20 10 40
45327 0 5 5 28 13 51
45330 13 3 5 10 10 41
45331 13 3 5 15 10 46
45332 15 3 5 20 10 53
45333 14 3 5 15 10 47
45334 15 3 5 20 10 53
45335 14 3 5 15 10 47
45337 20 3 5 25 15 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
45338 15 3 5 15 10 48
45340 15 3 5 20 15 58
45341 20 3 5 30 15 73
45342 23 3 5 45 20 96
45346 15 3 5 20 10 53
45347 23 3 5 35 15 81
45349 15 3 5 30 15 68
45350 14 3 5 20 13 55
45378 14 3 5 25 15 62
45379 15 3 5 35 15 73
45380 14 3 5 28 15 65
45381 14 3 5 28 15 65
45382 23 3 5 40 15 86
45384 14 3 5 28 15 65
45385 15 3 5 30 15 68
45386 20 3 5 35 15 78
45388 15 3 5 35 15 73
45389 23 3 5 45 17 93
45390 15 3 5 45 15 83
45391 23 3 5 45 20 96
45392 23 3 5 60 20 111
45393 23 3 5 40 15 86
45395 45 35 10 210 30 645
45397 45 35 10 240 30 675
45398 15 3 5 30 15 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
45400 45 25 10 100 30 410
45402 45 35 10 150 30 470
45499 0 0 0 0 0 0
45500 27 0 25 57 21 266
45505 90 0 0 82.5 30 300.5
45520 12 0 0 21 11 44
45540 90 0 0 117.5 30 481.5
45541 90 0 0 100 30 420
45550 70 0 0 180 30 540
45560 90 0 0 90 30 367
45562 90 0 0 95 30 561
45563 90 0 0 130 30 636
45800 90 0 0 120 30 570
45805 90 0 0 145 30 595
45820 90 0 0 100 30 480
45825 90 0 0 140 30 646
45900 90 0 0 15 20 219
45905 60 0 0 15 20 130
45910 60 0 0 15 20 130
45915 60 0 0 30 20 145
45990 30 10 10 20 25 95
45999 0 0 0 0 0 0
46020 20 0 0 35 20 126
46030 11 0 0 18 10 47
46040 30 15 15 30 20 184
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
46045 30 15 15 30 30 197
46050 12 0 0 19 12 59
46060 30 15 15 40 20 201
46070 16 0 0 19 15 74
46080 16 0 15 28 13 99
46083 12 0 0 16 7 51
46200 21 0 25 31 19 171
46220 14 0 0 23 14 67
46221 15 0 0 15 15 68
46230 14 0 0 30 14 74
46250 60 0 0 40 30 188
46255 60 0 0 45 30 193
46257 60 0 0 55 30 203
46258 60 0 0 70 30 241
46260 60 0 0 60 30 208
46261 60 0 0 70 30 241
46262 40 0 0 45 20 179
46270 30 15 15 15 20 169
46275 30 15 15 30 20 184
46280 30 15 15 45 20 199
46285 30 15 15 30 20 184
46288 60 0 0 65 30 236
46320 14 0 0 19 14 55
46500 8 5 3 10 10 59
46505 20 10 5 15 10 102
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
46600 2 5 0 5 10 22
46601 7 5 1 20 10 43
46604 7 5 0 12 10 34
46606 15 5 5 11 10 46
46607 17 5 5 25 10 62
46608 15 5 5 15 10 50
46610 15 5 5 15 10 50
46611 15 5 5 15 10 50
46612 15 5 5 16 10 51
46614 7 5 0 15 10 37
46615 15 5 5 20 13 58
46700 90 0 0 82.5 30 283.5
46705 27 0 25 50 21 277
46706 35 0 0 15 15 100
46707 33 10 15 40 15 187
46710 60 20 10 90 30 370
46712 60 20 10 240 30 670
46715 28 0 25 62 22 265
46716 115 0 0 90 30 530
46730 115 0 0 180 30 775
46735 115 0 0 230 30 850
46740 115 0 0 180 30 775
46742 115 0 0 240 30 895
46744 138 0 0 360 45 1303
46746 138 0 0 480 43 1566
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
46748 138 0 0 600 43 1686
46750 90 0 0 95 30 475
46751 30 0 25 69 21 299
46753 90 0 0 60 30 297
46754 20 0 0 20 15 175
46760 90 0 0 170 30 676
46761 90 0 0 90 30 410
46762 90 0 0 120 30 531
46900 15 0 0 15 10 40
46910 14 0 0 31 12 73
46916 14 0 0 25 12 67
46917 14 0 0 31 12 73
46922 17 0 0 35 15 83
46924 21 0 0 38 18 93
46930 8 5 0 5 5 46
46940 15 0 0 25 15 63
46942 16 0 0 28 15 67
46945 30 0 0 15 30 114
46946 30 0 0 25 30 101
46947 40 10 10 30 22 170
46999 0 0 0 0 0 0
47000 14 1 5 20 15 55
47001 0 0 0 26 14 40
47010 75 0 0 100 30 645
47015 75 0 0 120 30 665
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
47100 75 0 0 60 30 345
47120 75 0 0 225 30 803
47122 75 0 0 300 45 1000
47125 75 0 0 225 45 855
47130 75 0 0 240 45 870
47133 120 0 0 180 60 360
47135 90 20 30 420 75 1648
47140 90 15 15 355 60 1073
47141 105 15 15 420 60 1101
47142 105 15 15 480 60 1221
47143 0 0 0 0 0 0
47144 0 0 0 0 0 0
47145 0 0 0 0 0 0
47146 0 0 0 60 0 60
47147 0 0 0 65 0 65
47300 75 0 0 100 30 605
47350 75 0 0 90 30 575
47360 75 0 0 157.5 45 857.5
47361 75 0 0 190 45 1035
47362 75 0 0 90 45 880
47370 80 0 0 180 30 450
47371 80 0 0 180 35 455
47379 0 0 0 0 0 0
47380 85 0 0 200 45 550
47381 85 0 0 210 45 576
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
47382 20 0 0 180 30 265
47383 23 15 5 90 28 196
47399 0 0 0 0 0 0
47400 75 0 0 180 45 810
47420 75 0 0 180 30 588
47425 75 0 0 180 30 628
47460 75 0 0 130 30 578
47480 75 0 0 80 30 495
47490 33 10 5 30 15 133
47531 18 3 6 15 12 54
47532 20 3 5 45 15 88
47533 23 3 5 60 20 111
47534 23 3 5 68 20 119
47535 15 3 5 45 15 83
47536 10 3 5 20 13 51
47537 18 3 6 15 10 52
47538 20 3 5 53 15 96
47539 23 3 5 75 20 126
47540 23 3 5 85 20 136
47541 23 3 5 60 20 111
47542 30 30
47543 30 30
47544 45 45
47550 14 0 15 30 15 74
47552 20 0 25 44 20 109
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
47553 19 0 25 48 19 111
47554 22 0 25 68 22 137
47555 21 0 25 68 21 135
47556 30 10 20 89 35 184
47562 40 10 15 80 25 228
47563 40 10 15 90 25 238
47564 40 10 15 120 30 415
47570 60 0 0 195 85 340
47579 0 0 0 0 0 0
47600 40 10 20 120 30 475
47605 40 10 20 135 30 490
47610 75 0 0 120 30 512
47612 75 0 0 150 45 597
47620 75 0 0 180 45 627
47700 39 0 25 150 28 456
47701 42 0 25 176 31 498
47711 75 0 0 180 45 670
47712 75 0 0 210 45 790
47715 75 0 0 180 45 650
47720 75 0 0 90 45 520
47721 75 0 0 120 45 610
47740 75 0 0 120 45 590
47741 75 0 0 150 45 640
47760 45 15 15 195 45 759
47765 45 15 15 290 53 882
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
47780 45 15 15 240 40 799
47785 45 15 15 360 40 939
47800 75 0 0 162.5 45 652.5
47801 75 0 0 110 30 525
47802 75 0 0 160 30 705
47900 75 0 0 120 45 570
47999 0 0 0 0 0 0
48000 83 0 0 120 30 743
48001 83 0 0 142.5 45 815.5
48020 83 0 0 125 30 678
48100 83 0 0 77.5 30 497.5
48102 20 0 15 41 17 120
48105 82.5 0 0 180 37.5 1220
48120 83 0 0 135 30 595
48140 90 0 0 150 45 725
48145 90 0 0 187.5 45 762.5
48146 90 0 0 225 45 893
48148 90 0 0 165 45 700
48150 90 0 0 345 45 1110
48152 90 0 0 300 45 1063
48153 90 0 0 315 45 1078
48154 90 0 0 290 45 1033
48155 90 0 0 300 45 1043
48160 0 0 0 0 0 0
48400 0 0 0 45 0 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
48500 83 0 0 120 30 603
48510 83 0 0 97.5 30 580.5
48520 83 0 0 120 30 580
48540 83 0 0 140 30 560
48545 83 0 0 120 45 773
48547 83 0 0 180 45 903
48548 90 0 0 190 45 765
48550 60 0 0 200 0 260
48551 0 0 0 0 0 0
48552 0 0 0 50 0 50
48554 120 0 0 300 440 1237
48556 60 0 0 180 225 952
48999 0 0 0 0 0 0
49000 60 0 0 90 30 304
49002 30 15 15 75 30 437
49010 30 15 15 90 30 357
49020 60 0 0 120 30 710
49040 60 0 0 85 45 603
49060 60 0 0 85 45 563
49062 90 0 0 90 30 334
49082 13 1 6 10 10 40
49083 15 5 5 25 10 60
49084 15 3 5 20 15 58
49180 12 0 15 22 10 59
49185 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
49203 45 10 15 120 30 420
49204 58 8 15 160 30 511
49205 50 10 15 225 30 645
49215 118 0 0 180 35 855
49220 37 0 25 132 28 438
49250 25 0 25 52 22 292
49255 38 0 0 90 30 345
49320 40 0 0 45 30 157
49321 45 0 0 45 30 201
49322 45 0 0 45 20 133
49323 75 0 0 90 30 299
49324 20 10 10 60 20 162
49325 20 10 10 60 20 162
49326 0 0 0 45 0 45
49327 0 0 0 30 0 30
49329 0 0 0 0 0 0
49400 15 0 0 25 13 53
49402 60 0 0 60 30 422
49405 25 5 5 40 20 95
49406 25 5 5 40 20 95
49407 25 5 5 45 20 100
49411 9 1 5 40 20 75
49412 0 0 0 20 0 20
49418 23 6 5 40 20 94
49419 60 0 0 60 30 231
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
49421 33 3 10 45 20 111
49422 30 0 0 48 60 212
49423 15 0 0 30 15 60
49424 12 0 0 15 10 37
49425 30 0 25 81 25 367
49426 28 0 25 66 23 330
49427 5 5 5 30 5 50
49428 45 0 0 35 22.5 239.5
49429 53 0 0 60 120 407
49435 0 0 0 30 0 30
49436 15 5 10 15 13 93
49440 25 5 8 38 20 116
49441 25 5 8 45 20 123
49442 25 5 8 30 20 108
49446 15 8 5 40 15 83
49450 20 5 5 10 10 50
49451 20 5 5 15 10 55
49452 20 5 5 20 10 60
49460 20 5 5 15 10 55
49465 5 5 5 10 10 35
49491 90 0 0 60 30 398
49492 90 0 0 60 30 398
49495 45 0 0 50 30 148
49496 80 0 0 60 60 246
49500 45 0 0 45 30 178
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
49501 45 0 0 60 30 232
49505 20 15 15 70 20 198
49507 40 3 20 70 40 231
49520 45 0 0 60 22.5 185.5
49521 40 3 20 90 40 251
49525 45 0 0 60 30 193
49540 45 0 0 85 30 218
49550 45 0 0 60 30 193
49553 45 0 0 75 30 247
49555 45 0 0 85 30 218
49557 45 0 0 90 30 262
49560 45 0 0 90 30 223
49561 45 0 0 100 30 352
49565 45 0 0 100 30 312
49566 45 0 0 120 30 372
49568 0 0 0 52 0 52
49570 45 0 0 60 30 193
49572 45 0 0 60 30 312
49580 45 0 0 37.5 30 170.5
49582 45 0 0 47.5 30 219.5
49585 45 0 0 45 30 178
49587 40 3 20 60 40 221
49590 45 0 0 60 30 193
49600 27 0 25 57 19 286
49605 110 0 0 120 50 1720
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
49606 33 0 25 86 25 297
49610 31 0 25 74 24 282
49611 29 0 25 66 22 270
49650 25 0 0 60 30 147
49651 25 0 0 90 30 193
49652 40 15 15 90 40 258
49653 40 15 15 120 50 314
49654 40 15 15 120 50 298
49655 40 15 15 150 50 344
49656 45 15 15 120 30 362
49657 60 15 15 180 30 493
49659 0 0 0 0 0 0
49900 30 0 0 60 30 567
49904 83 0 0 205 30 670
49905 0 0 0 92 0 92
49906 90 0 0 420 60 892
49999 0 0 0 0 0 0
50010 32 0 25 93 24 341
50020 70 0 0 90 60 650
50040 60 0 0 90 45 405
50045 35 0 25 121 24 382
50060 33 0 25 133 22 440
50065 40 0 25 172 27 471
50070 41 0 25 182 27 482
50075 45 0 25 242 29 569.5
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
50080 41 0 25 117 41 359.5
50081 42 0 25 195 27 507.5
50100 37 0 25 135 26 400
50120 34 0 25 112 24 362
50125 35 0 25 113 24 364
50130 31 0 25 143 21 427
50135 40 0 25 164 27 443
50200 35 0 0 53 15 103
50205 60 0 0 75 45 324
50220 60 0 0 120 45 432
50225 60 0 0 180 45 512
50230 41 0 25 222 30 573.5
50234 60 0 0 180 45 512
50236 60 0 0 190 50 570
50240 75 0 0 180 60 605
50250 17.5 20 17.5 145 30 541
50280 33 0 25 110 24 379
50290 34 0 25 116 24 386
50300 60 0 0 120 0 180
50320 120 0 0 180 100 598
50323 0 0 0 0 0 0
50325 0 0 0 0 0 0
50327 0 0 0 44 0 44
50328 0 0 0 45 0 45
50329 0 0 0 45 0 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
50340 32 0 25 107 24 436.5
50360 90 3 20 210 45 774
50365 73 0 25 219 64 1446
50370 33 0 25 126 24 898
50380 73 0 25 242 64 1469
50382 20 10 10 60 15 115
50384 15 7 10 55 15 102
50385 19 10 10 45 15 99
50386 15 10 10 30 15 80
50387 14 9 10 18 10 61
50389 5 10 10 10 5 40
50390 24 0 0 38 21 83
50391 13 7.5 0 30 10 60.5
50395 29 0 0 46 24 99
50396 14 0 0 32 10 56
50400 37 0 25 148 26 483
50405 42 0 25 197 28 550.5
50430 20 1 5 35 20 81
50431 18 1 6 15 15 55
50432 23 1 5 48 20 97
50433 23 1 5 60 20 109
50434 20 1 5 45 20 91
50435 13 1 6 20 15 55
50500 38 0 25 146 27 463
50520 37 0 25 149 27 465
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
50525 41 0 25 186 29 569.5
50526 49 0 25 199 33 624.5
50540 43 0 15 190 26 421
50541 60 0 0 120 15 319
50542 75 0 0 180 30 449
50543 60 0 0 240 30 557
50544 60 0 0 240 15 459
50545 60 0 0 240 30 491
50546 60 0 0 205 17.5 466.5
50547 92.5 0 0 240 45 501.5
50548 60 0 0 270 20 494
50549 0 0 0 0 0 0
50551 22 0 25 49 22 118
50553 23 0 25 66 23 137
50555 24 0 25 65 24 138
50557 25 0 25 74 25 149
50561 27 0 25 94 26 172
50562 46 0 0 92.5 30 187.5
50570 29 0 25 95 28 177
50572 30 0 25 104 29 188
50574 32 0 25 114 30 201
50575 60 0 0 180 60 300
50576 32 0 25 114 30 201
50580 33 0 25 127 31 216
50590 33 3 15 60 15 207
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
50592 0 10 10 60 30 145
50593 35 10 10 90 20 207
50600 32 0 25 95 24 361.5
50605 32 0 25 95 24 361.5
50606 0 0 0 45 0 45
50610 32 0 25 88 24 354.5
50620 30 0 25 76 24 330.5
50630 29 0 25 91 19 339.5
50650 35 0 25 115 25 387
50660 38 0 25 148 26 434
50684 20 0 0 20 15 55
50686 15 0 0 36 12 63
50688 13 0 0 18 13 52
50690 12 0 0 17 12 41
50693 23 1 5 45 20 94
50694 23 1 5 62 20 111
50695 23 1 5 75 20 124
50700 36 0 25 131 26 415
50705 0 0 0 60 0 60
50706 0 0 0 60 0 60
50715 60 0 0 135 45 467
50722 35 0 25 120 26 423
50725 39 0 25 157 28 486
50727 7 5 5 75 20 225
50728 7 5 5 106 20 286
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
50740 38 0 25 148 27 465
50750 40 0 25 177 28 507
50760 37 0 25 135 27 451
50770 39 0 25 160 28 489
50780 34 0 25 115 22 413
50782 7 5 5 200 20 384
50783 7 5 5 227 20 427
50785 39 0 25 156 28 485
50800 42 0 25 123 32 470.5
50810 55 0 25 283 37 731.5
50815 50 0 25 208 37 630
50820 44 0 25 210 29 606.5
50825 59 0 25 296 41 761
50830 58 0 25 298 40 761
50840 52 0 25 245 36 678
50845 90 0 0 240 240 823
50860 35 0 25 110 27 434
50900 33 0 25 92 26 363
50920 37 0 25 123 27 409
50930 40 0 25 146 30 438
50940 35 0 25 109 27 383
50945 60 0 0 120 17.5 341.5
50947 60 0 0 255 30 512
50948 60 0 0 240 30 506
50949 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
50951 22 0 25 53 23 123
50953 24 0 25 61 24 134
50955 25 0 25 68 25 143
50957 25 0 25 71 25 146
50961 23 0 25 55 24 127
50970 28 0 25 108 26 187
50972 27 0 25 108 25 185
50974 30 0 25 110 29 194
50976 30 0 25 108 28 191
50980 25 0 25 67 25 142
51020 29 0 25 66 21 266.5
51030 29 0 25 73 22 284.5
51040 16 0 25 33 14 139
51045 28 0 25 62 21 271.5
51050 22 0 25 57 18 276
51060 33 0 25 92 24 319.5
51065 32 0 25 93 23 318.5
51080 28 0 25 59 22 238
51100 10 0 0 13 10 33
51101 12 0 15 18 12 57
51102 19 1 5 20 15 60
51500 33 0 25 94 23 290.5
51520 31 0 25 78 22 271.5
51525 27 0 25 109 20 386.5
51530 31 0 25 92 24 357.5
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
51535 33 0 25 107 24 374.5
51550 32 0 25 114 23 419.5
51555 38 0 25 166 28 534
51565 42 0 25 196 30 571.5
51570 41 0 25 161 31 710
51575 47 0 25 233 35 863.5
51580 56 0 25 280 40 987.5
51585 60 0 25 340 42 1073.5
51590 50 0 25 366 36 990.5
51595 54 0 25 328 47 1039
51596 67 0 25 445 46 1231
51597 90 0 0 300 60 1023
51600 20 0 0 20 15 55
51605 11 0 0 16 8 35
51610 20 0 0 20 15 55
51700 5 5 5 5 5 25
51701 5 5 4 5 5 24
51702 5 5 5 5 5 25
51703 10 5 5 15 10 45
51705 7 5 0 10 10 32
51710 7 5 0 15 15 42
51715 30 0 0 45 60 135
51720 5 1 3 5 5 19
51725 20 0 0 25 15 60
51726 25 0 0 30 15 70
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
51727 20 0 0 35 10 65
51728 20 0 0 35 10 65
51729 20 0 0 40 15 75
51736 0 0 0 5 2 7
51741 0 0 0 5 2 7
51784 5 5 5 20 10 45
51785 10 20 30
51792 15 0 0 20 10 45
51797 0 0 0 15 0 15
51800 39 0 25 146 27 434
51820 43 0 25 196 29 511.5
51840 27 0 25 78 21 319
51841 29 0 25 112 20 354
51845 26 0 25 66 20 265
51860 29 0 25 66 24 308
51865 35 0 25 118 26 398
51880 27 0 25 54 20 216
51900 40 0 25 167 28 487
51920 39 0 25 149 28 458
51925 42 0 25 181 30 536.5
51940 50 0 25 252 36 671.5
51960 52 0 25 229 37 663
51980 30 0 25 77 23 320.5
51990 60 0 0 120 20 324
51992 60 0 0 120 20 324
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
51999 0 0 0 0 0 0
52000 10 5 5 10 10 40
52001 50 0 0 60 20 130
52005 19 5 5 30 20 79
52007 19 5 5 32.5 20 81.5
52010 19 0 25 43 19 106
52204 10 2 5 25 12 54
52214 19 5 5 30 20 79
52224 19 5 5 30 20 79
52234 19 5 5 30 20 79
52235 19 5 5 45 20 94
52240 33 5 15 60 20 133
52250 24 0 25 46 18 113
52260 23 0 15 32 17 87
52265 21 0 0 26 16 63
52270 20 0 25 27 13 85
52275 30 0 0 30 30 90
52276 30 0 0 35 30 95
52277 45 0 0 45 40 130
52281 10 1 5 20 10 46
52282 40 0 0 50 30 120
52283 14 0 25 34 13 86
52285 14 0 15 38 14 81
52287 7 5 10 21 15 58
52290 24 0 25 34 18 101
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
52300 26 0 25 45 19 115
52301 70 0 0 45 30 183
52305 25 0 25 42 18 110
52310 7 5 0 40 20 72
52315 19 5 5 45 20 94
52317 22 0 25 51 19 117
52318 31 0 25 77 23 156
52320 32 0 25 58 28 143
52325 30 0 25 104 24 183
52327 45 0 0 60 30 135
52330 28 0 25 64 20 137
52332 15 1 5 25 10 56
52334 25 0 25 49 15 114
52341 45 10 15 45 20 135
52342 40 10 10 60 20 140
52343 45 10 10 60 25 150
52344 40 10 10 45 20 125
52345 45 10 15 45 20 135
52346 40 10 10 60 20 140
52351 33 5 15 45 20 118
52352 33 5 15 45 20 118
52353 33 5 15 60 20 133
52354 33 5 15 60 20 133
52355 33 5 15 90 20 163
52356 33 5 15 60 20 133
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
52400 72.5 10 15 40 25 197.5
52402 30 0 0 50 15 95
52441 17 5 20 30 21 93
52442 0 0 0 25 0 25
52450 15 5 5 81 15 209
52500 45 10 15 45 27.5 230.5
52601 35 10 15 75 40 355
52630 33 5 15 60 35 222
52640 33 5 15 30 20 184
52647 60 0 0 45 45 219
52648 60 0 0 60 60 249
52649 33 5 15 120 25 279
52700 25 0 25 37 20 201
53000 16 0 15 41 12 138
53010 25 0 25 44 20 228
53020 13 0 15 15 11 54
53025 10 0 15 8 8 41
53040 23 0 25 33 18 179
53060 14 0 0 24 14 68
53080 25 0 25 40 19 193
53085 29 0 25 64 21 254.5
53200 14 0 15 20 11 60
53210 33 0 25 87 25 325.5
53215 31 0 25 117 23 371.5
53220 27 0 25 45 20 201
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
53230 33 0 25 81 23 267.5
53235 35 0 25 92 24 281.5
53240 26 0 25 45 19 199
53250 29 0 0 57 21 153
53260 17 0 0 28 13 74
53265 19 0 0 26 15 76
53270 16 0 0 30 12 93
53275 18 0 15 40 13 121
53400 28 0 25 91 22 343
53405 33 0 25 102 23 330
53410 36 0 25 122 24 364
53415 41 0 25 164 27 424
53420 35 0 25 111 24 340.5
53425 36 0 25 118 25 349.5
53430 36 0 25 113 25 344.5
53431 41 0 25 166 27 426
53440 33 7 15 90 22 248
53442 65 0 0 90 30 395
53444 50 0 0 120 30 320
53445 50 15 20 90 35 314
53446 50 0 0 100 30 300
53447 50 0 0 140 30 340
53448 60 0 0 170 30 564
53449 33 0 25 94 23 280.5
53450 26 0 15 58 19 202
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
53460 28 0 15 58 20 205
53500 50 0 0 90 29 289
53502 28 0 25 54 21 212
53505 29 0 25 59 21 218
53510 34 0 25 82 24 270.5
53515 37 0 25 120 25 322.5
53520 32 0 25 76 22 250.5
53600 15 0 0 20 0 35
53601 8 0 0 14 8 30
53605 11 0 0 18 11 40
53620 15 0 0 10 0 25
53621 12 0 0 21 12 45
53660 11 0 0 12 11 34
53661 8 0 0 10 8 26
53665 13 0 0 15 8 36
53850 7 5 15 60 15 204
53852 60 0 0 58 45 232
53855 7 0 0 15 10 32
53860 7 0 0 30 15 98
53899 0 0 0 0 0 0
54000 13 0 0 15 10 54
54001 16 0 0 25 12 69
54015 21 0 15 32 16 119
54050 12 0 0 15 11 54
54055 11 0 0 14 11 44
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
54056 13 0 0 18 9 56
54057 14 0 0 29 14 73
54060 14 0 0 26 10 66
54065 14 0 0 27 11 68
54100 16 0 15 19 14 64
54105 20 0 15 36 15 102
54110 33 0 25 79 24 256.5
54111 39 0 25 123 26 318.5
54112 40 0 25 140 26 368
54115 26 0 25 46 15 207.5
54120 28 0 25 63 21 272.5
54125 32 0 25 82 24 298.5
54130 42 0 25 188 29 502.5
54135 48 0 25 256 32 599.5
54150 15 5 5 15 5 45
54160 18 0 0 36 13 83
54161 15 0 0 45 12 88
54162 25 0 0 30 10 107
54163 25 0 0 30 10 107
54164 25 0 0 20 10 97
54200 20 0 0 20 15 71
54205 25 0 25 63 14 262.5
54220 21 0 0 46 15 82
54230 14 0 0 26 12 52
54231 15 0 0 30 15 60
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
54235 14 0 0 15 14 43
54240 14 0 0 25 9 48
54250 25 0 0 52 12 89
54300 40 0 0 124 28 268.5
54304 40 0 15 116 26 273.5
54308 39 0 0 110 28 234.5
54312 42 0 25 134 28 317
54316 40 0 25 153 26 401
54318 30 0 25 86 21 309
54322 34 0 25 101 22 307.5
54324 38 0 25 128 26 374
54326 41 0 25 178 26 437
54328 39 0 25 149 25 395
54332 41 0 25 161 27 421
54336 35 0 25 167 25 450.5
54340 33 0 25 78 22 234.5
54344 39 0 25 145 25 371
54348 42 0 25 167 27 408
54352 48 0 25 226 30 497.5
54360 34 0 25 93 23 280.5
54380 40 0 25 128 27 337
54385 46 0 25 195 30 424.5
54390 50 0 25 229 32 464.5
54400 36 0 25 66 22 237
54401 15 5 5 103 15 248
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
54405 33 0 25 115 23 272.5
54406 50 0 0 95 30 295
54408 50 0 0 110 30 334
54410 40 10 15 120 40 329
54411 50 0 0 180 30 580
54415 50 0 0 60 30 221
54416 50 0 0 75 30 315
54417 50 0 0 108 30 465
54420 35 0 25 116 23 324.5
54430 31 0 25 81 21 273.5
54435 22 0 25 35 17 193
54437 33 3 15 60 30 264
54438 40 3 15 180 28 531
54440 60 0 0 120 60 386
54450 12 0 0 15 9 36
54500 12 0 0 15 10 37
54505 19 0 15 33 14 97
54512 50 0 0 70 30 216
54520 21 0 25 40 15 144
54522 45 0 0 75 25 211
54530 57.5 10 15 60 30 246.5
54535 32 0 25 83 23 298.5
54550 30 0 25 68 21 228
54560 33 0 25 98 22 303.5
54600 26 0 25 49 18 202
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
54620 23 0 15 32 15 127
54640 33 0 0 62 45 220
54650 52 0 0 120 60 301
54660 25 0 15 40 18 163
54670 30 0 0 60 42 230
54680 31 0 25 89 24 364.5
54690 75 0 0 90 60 329
54692 60 0 0 120 15 319
54699 0 0 0 0 0 0
54700 20 0 15 31 15 97
54800 12 0 15 16 9 52
54830 26 0 15 45 19 170
54840 21 0 15 52 15 146
54860 28 0 25 56 20 194
54861 35 0 25 85 24 245.5
54865 23 0 15 45 15 182
54900 40 0 25 136 27 345
54901 48 0 25 213 31 445.5
55000 10 0 0 16 10 36
55040 29 0 15 50 17 162
55041 32 0 25 78 21 232.5
55060 26 0 25 51 18 185
55100 16 0 15 23 13 90
55110 24 0 25 43 18 194
55120 24 0 15 43 18 165
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
55150 38 0 25 80 21 279.5
55175 26 0 25 52 18 186
55180 28 0 25 99 18 297
55200 17 0 15 35 8 98
55250 17 0 15 41 8 105
55300 17 0 15 43 10 85
55400 29 0 0 84 14 186
55450 16 0 15 29 12 114
55500 26 0 25 49 19 184
55520 27 0 25 52 19 188
55530 21 0 15 50 15 152
55535 27 0 25 50 20 187
55540 29 0 25 65 21 224
55550 45 0 0 75 30 196
55559 0 0 0 0 0 0
55600 31 0 0 86 22 204
55605 33 0 0 66 23 198.5
55650 37 0 25 112 25 304.5
55680 18 0 25 77 14 206.5
55700 5 5 5 15 5 35
55705 21 0 15 37 14 122
55706 33 5 15 45 15 195
55720 30 0 0 65 23 150
55725 27 0 25 59 17 305
55801 36 0 25 142 26 497.5
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
55810 42 0 25 186 25 515
55812 46 0 25 262 31 684
55815 49 0 25 325 32 771
55821 32 0 25 102 25 399.5
55831 31 0 25 114 27 422.5
55840 33 3 15 180 33 448
55842 33 3 15 180 33 448
55845 33 3 15 198 33 466
55860 32 0 25 95 24 371.5
55862 36 0 25 137 25 450
55865 36 0 25 185 28 492.5
55866 33 20 15 180 30 442
55870 15 0 0 30 15 60
55873 33 8 15 100 30 274
55875 50 0 0 90 40 249
55876 19 10 0 20 10 59
55899 0 0 0 0 0 0
55920 30 10 15 90 30 175
55970 0 0 0 0 0 0
55980 0 0 0 0 0 0
56405 13 0 0 15 12 56
56420 13 0 0 15 12 56
56440 19 0 15 23 20 93
56441 10 0 15 16 10 67
56442 10 0 0 12 10 32
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
56501 14 0 0 15 10 55
56515 50 0 0 45 20 157
56605 10 0 0 15 10 35
56606 0 0 0 0 0 15
56620 45 10 5 45 30 239
56625 31 0 25 82 28 341.5
56630 35 0 25 115 32 562.5
56631 105 0 0 172.5 45 658.5
56632 120 0 0 240 360 1013
56633 60 0 0 120 45 602
56634 105 0 0 200 45 686
56637 105 0 0 240 45 726
56640 40 0 25 154 36 640.5
56700 17 0 15 22 17 94
56740 50 0 0 45 20 176
56800 18 0 15 33 15 116
56805 120 0 0 150 30 460
56810 18 0 0 30 16 119
56820 15 0 0 15 10 40
56821 15 0 0 20 10 45
57000 11 0 0 41 11 79
57010 22 0 25 45 23 229
57020 9 0 0 14 9 32
57022 30 0 0 30 20 116
57023 45 0 0 45 30 201
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
57061 11 0 0 17 11 55
57065 14 0 0 34 14 78
57100 15 0 0 15 10 40
57105 14 0 15 22 12 79
57106 26 0 0 48 38 239
57107 75 0 0 180 40 515
57109 60 0 0 240 52.5 539.5
57110 60 0 0 120 42 386
57111 82.5 0 0 240 45 554.5
57112 90 0 0 270 60 627
57120 29 0 25 52 23 253
57130 9 0 0 28 9 54
57135 9 0 0 30 9 56
57150 10 0 0 10 5 25
57155 23 5 5 60 30 123
57156 18 5 6 30 20 79
57160 10 5 5 15 5 40
57170 9 0 0 19 9 37
57180 13 0 0 18 12 59
57200 21 0 15 31 18 138.5
57210 23 0 25 40 20 190.5
57220 24 0 25 42 21 194.5
57230 23 0 25 38 21 209.5
57240 45 5 10 60 30 307
57250 45 5 10 60 30 307
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
57260 45 5 10 90 30 337
57265 45 5 10 120 30 367
57267 0 0 0 45 0 45
57268 26 0 25 46 23 234
57270 55 0 0 90 37 381
57280 60 0 0 115 45 439
57282 27 0 25 70 27 294.5
57283 60 12 15 95 30 349
57284 45 10 5 100 30 327
57285 45 10 5 60 30 267
57287 33 7 15 60 20 239
57288 33 7 15 60 27 246
57289 60 0 0 90 35 373
57291 31 0 25 72 26 248
57292 35 0 25 99 29 322
57295 15 15 15 60 20 202
57296 45 10 10 120 40 429
57300 28 0 25 52 21 271.5
57305 60 0 0 120 40 468
57307 37 0 25 120 24 363
57308 60 0 0 90 30 313
57310 28 0 25 58 24 259
57311 33 0 25 101 26 319
57320 30 0 25 73 25 277
57330 32 0 25 80 27 288
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
57335 120 0 0 180 30 459
57400 30 0 0 20 30 80
57410 30 0 0 15 25 70
57415 45 0 0 15 30 113
57420 14.10000038 0 0 18.5 10 42.60000038
57421 15 0 0 20 10 45
57423 45 10 5 150 30 357
57425 60 10 20 120 30 404
57426 40 3 20 110 40 360
57452 15 0 0 15 10 40
57454 15 0 0 20 10 45
57455 15 0 0 20 10 45
57456 15 0 0 20 10 45
57460 15 0 0 25 10 50
57461 15 0 0 28 15 58
57500 7 1 1 15 5 29
57505 7 0 0 6 7 36
57510 7 0 0 17 7 31
57511 12 0 0 15 12 55
57513 23 0 15 21 13 88
57520 22 0 15 26 23 110
57522 15 0 0 20 120 178
57530 21 0 25 40 22 180.5
57531 70 0 0 240 30 604
57540 50 0 0 75 40 309
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
57545 60 0 0 120 40 364
57550 24 0 25 44 21 228
57555 31 0 25 85 26 311
57556 29 0 25 68 26 292
57558 15 0 0 11 13 55
57700 27 0 0 27 18 129.5
57720 23 0 0 40 20 136.5
57800 10 0 0 8 10 28
58100 20 0 0 10 5 35
58110 0 0 0 9 0 9
58120 20 5 10 25 27 129
58140 60 0 0 120 30 374
58145 30 0 25 61 27 267
58146 70 0 0 150 30 429
58150 45 5 10 120 30 394
58152 35 0 25 113 25 373.5
58180 60 0 0 130 40 414
58200 60 0 0 150 45 459
58210 75 0 0 240 45 627
58240 75 30 15 420 75 1118
58260 60 0 0 60 30 311
58262 60 0 0 91 30 342
58263 60 0 0 112 30 363
58267 39 0 25 120 23 392.5
58270 31 0 25 72 22 304
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
58275 35 0 25 100 30 365.5
58280 36 0 25 110 31 387.5
58285 87.5 0 0 205 30 499.5
58290 75 0 0 120 30 389
58291 75 0 0 141 30 410
58292 75 0 0 154 30 423
58293 75 0 0 164 30 433
58294 75 0 0 136 30 405
58300 0 0 0 16 0 16
58301 15 0 0 15 10 40
58321 10 0 0 15 15 40
58322 13 0 0 15 15 43
58323 10 0 0 15 5 30
58340 7 0 0 15 7 29
58345 21 0 0 50 10 116
58346 50 0 0 60 20 267
58350 10 0 0 17 10 53
58353 52.5 0 0 30 15 151.5
58356 30 10 10 45 30 167
58400 20 0 25 53 21 241.5
58410 60 0 0 110 40 354
58520 40 0 0 90 50 379
58540 60 0 0 120 40 364
58541 33 8 15 75 30 226
58542 33 8 15 88 30 239
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
58543 33 8 15 110 30 261
58544 33 8 15 120 30 271
58545 60 0 0 120 30 334
58546 60 0 0 180 30 394
58548 60 10 5 240 45 564
58550 60 0 0 100 30 330
58552 60 0 0 120 30 350
58553 60 0 0 150 37.5 391.5
58554 60 0 0 167.5 37.5 425
58555 33 8 15 20 20 96
58558 33 8 15 30 20 106
58559 33 8 15 40 20 116
58560 33 8 15 40 20 116
58561 33 8 15 45 20 121
58562 33 8 15 25 20 101
58563 33 8 15 30 20 106
58565 35 10 15 50 30 191
58570 33 8 15 90 30 241
58571 33 8 15 90 30 241
58572 33 8 15 120 30 271
58573 33 8 15 130 30 281
58578 0 0 0 0 0 0
58579 0 0 0 0 0 0
58600 50 0 0 35 20 166
58605 40 0 0 30 15 141
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
58611 0 0 0 13.5 0 13.5
58615 19 0 15 32 17 99
58660 47.5 0 0 90 30 209.5
58661 55 0 0 90 30 217
58662 45 0 0 80 30 186.5
58670 40 0 0 35 20 118
58671 40 0 0 35 20 118
58672 30 0 0 30 20 96
58673 30 0 0 112 20 185
58674 33 3 15 120 30 266
58679 0 0 0 0 0 0
58700 75 0 0 60 32.5 321.5
58720 37 5 10 90 30 309
58740 67.5 0 0 120 32.5 374
58750 60 0 0 120 40 357
58752 60 0 0 150 30 377
58760 60 0 0 120 40 357
58770 60 0 0 120 30 347
58800 22 0 25 23 17 159.5
58805 24 0 25 48 19 198.5
58820 22 0 0 36 20 131.5
58822 60 0 0 90 30 399
58825 60 0 0 65 20 282
58900 24 0 25 46 18 205.5
58920 25 0 25 53 19 214.5
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
58925 60 0 0 90 35 329
58940 22 0 25 54 22 257
58943 36 0 25 135 25 385
58950 70 0 0 120 30 420
58951 75 0 0 200 32.5 581.5
58952 60 0 0 240 60 710
58953 90 0 0 285 45 712
58954 90 0 0 320 55 757
58956 77.5 15 20 150 30 534.5
58957 65 10 15 180 45 552
58958 65 10 15 210 45 582
58960 60 0 0 150 45 449
58970 30 0 0 45 30 105
58974 0 0 0 0 0 0
58976 30 0 0 60 30 120
58999 0 0 0 0 0 0
59000 7 0 0 20 7 34
59001 40 0 0 45 20 105
59012 25 0 0 44 22 91
59015 17 0 0 18 9 44
59020 7 0 0 30 7 44
59025 9 0 0 7 9 25
59030 14 0 0 16 13 43
59050 0 0 0 28 0 28
59051 0 0 0 0 0 24
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
59070 40 15 10 30 30 125
59072 40 30 15 60 30 175
59074 40 15 10 30 30 125
59076 60 30 15 60 0 165
59100 60 0 0 60 35 329
59120 60 0 0 90 45 384
59121 60 0 0 90 30 324
59130 60 0 0 120 45 349
59135 34 0 25 92 29 334
59136 60 0 0 90 40 334
59140 26 0 25 42 21 186.5
59150 60 0 0 70 30 225
59151 60 0 0 80 30 235
59160 15 0 15 19 14 79
59200 8 0 0 6 8 22
59300 20 0 0 28 18 66
59320 20 0 0 34 18 72
59325 27 0 0 61 23 111
59350 28 0 25 70 25 148
59400 202.5 10 5 45 35 739.5
59409 202.5 10 5 45 35 297.5
59410 202.5 10 5 45 35 398.5
59412 13 1 6 20 15 55
59414 19 1 5 20 18 63
59425 0 0 0 0 0 137
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
59426 0 0 0 0 0 252
59430 0 0 0 0 0 63
59510 232.5 10 10 45 35 817.5
59514 232.5 10 10 45 35 332.5
59515 232.5 10 10 45 35 476.5
59525 0 0 0 43 0 43
59610 202.5 10 5 45 35 739.5
59612 202.5 10 5 45 35 297.5
59614 202.5 10 5 45 35 398.5
59618 202.5 10 10 50 35 792.5
59620 202.5 10 10 50 35 307.5
59622 202.5 10 10 50 35 451.5
59812 55 0 0 20 17.5 135.5
59820 25 0 15 24 18 162
59821 22 0 15 31 20 148
59830 19 0 15 30 17 115.5
59840 0 0 0 27 0 27
59841 45 0 0 35 45 203
59850 0 0 0 78 0 78
59851 0 0 0 97 0 97
59852 0 0 0 165 0 165
59855 40 0 0 65 30 158
59856 40 0 0 90 30 183
59857 45 0 0 180 60 301
59866 53 0 0 30 30 113
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
59870 70 0 0 40 20 256
59871 28 0 0 20 15 63
59897 0 0 0 0 0 0
59898 0 0 0 0 0 0
59899 0 0 0 0 0 0
60000 13 0 0 17 13 59
60100 15 0 0 25 10 50
60200 26 0 25 79 23 297
60210 60 0 0 105 60 264
60212 60 0 0 153 90 358
60220 40 12 20 90 40 267
60225 30 0 25 122 25 374
60240 40 12 20 150 40 327
60252 60 0 0 180 30 470
60254 60 0 0 210 30 500
60260 60 0 0 145 30 372
60270 60 0 0 180 30 650
60271 60 0 0 150 30 377
60280 25 0 25 76 22 262
60281 26 0 25 74 23 262
60300 20 0 0 15 15 50
60500 40 12 20 120 40 313
60502 35 0 25 166 29 465
60505 38 0 25 214 31 636
60512 0 0 0 45 0 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
60520 60 0 0 120 180 624
60521 60 0 0 180 180 595
60522 60 0 0 210 200 703
60540 40 0 25 156 30 485
60545 43 0 25 195 31 538
60600 45 15 15 180 30 429
60605 45 15 15 240 36 530
60650 70 0 0 180 30 384
60659 0 0 0 0 0 0
60699 0 0 0 0 0 0
61000 13 0 15 24 8 60
61001 12 0 15 21 9 57
61020 12 0 15 19 9 55
61026 13 0 15 21 9 58
61050 20 0 0 20 8 48
61055 15 0 15 31 7 68
61070 9 0 15 15 5 44
61105 21 0 25 27 18 152
61107 0 0 0 30 0 30
61108 25 5 25 44 22 326.5
61120 22 0 25 37 22 238.5
61140 37 11 25 83 26 367.5
61150 30 8 25 83 28 378
61151 26 6 25 57 26 312.5
61154 60 15 15 60 30 447
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
61156 28 7 25 70 27 339.5
61210 20 0 25 44 12 101
61215 24 5 25 46 23 275.5
61250 25 6 25 52 24 304.5
61253 27 7 25 66 26 333.5
61304 42 9 25 161 32 493
61305 42 13 25 197 35 617.5
61312 60 15 15 150 30 689
61313 100 0 0 150 40 687
61314 41 11 25 185 33 540.5
61315 41 15 25 211 38 625.5
61316 0 0 0 20 0 20
61320 40 12 25 174 35 570
61321 43 13 25 214 36 636.5
61322 90 0 0 150 50 893
61323 90 0 0 180 50 865
61330 40 12 25 192 33 597.5
61332 42 13 25 207 27 518
61333 42 10 25 265 27 573
61340 35 9 25 121 31 445
61343 45 14 25 233 37 669.5
61345 42 13 25 201 36 622.5
61450 39 12 25 156 35 541
61458 44 18 25 206 33 551.5
61460 44 13 25 216 36 609.5
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
61480 40 11 25 151 35 506
61500 33 9 25 145 25 412.5
61501 27 6 25 140 25 438.5
61510 105 0 0 200 40 635
61512 105 0 0 240 40 652
61514 41 12 25 191 35 599.5
61516 41 12 25 191 34 598.5
61517 0 0 0 15 0 15
61518 110 0 0 240 40 755
61519 120 0 0 300 45 732
61520 120 0 0 360 45 815
61521 55 18 25 411 42 928
61522 44 13 25 220 37 654.5
61524 43 13 25 203 36 625.5
61526 120 0 0 360 45 789
61530 49 13 25 492 35 869.5
61531 150 0 0 90 35 511
61533 38 11 25 156 33 537
61534 42 13 25 199 35 619.5
61535 31 8 25 87 29 414
61536 48 15 25 298 38 759.5
61537 60 20 20 265 45 614
61538 60 20 20 330 45 679
61539 48 15 25 297 38 758.5
61540 75 20 20 300 40 655
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
61541 45 14 25 240 36 675.5
61543 44 14 25 231 37 666.5
61544 42 13 25 188 36 598
61545 105 0 0 300 45 775
61546 46 14 25 255 38 703.5
61548 38 20 25 165 31 553
61550 41 5 15 108 22 279
61552 41 5 15 156 23 345.5
61556 115 0 0 225 33 692
61557 110 0 0 200 150 627
61558 120 0 0 300 34 661
61559 120 0 0 300 35 665
61563 100 0 0 283 34 656
61564 100 0 0 300 36 623
61566 75 20 20 240 35 610
61567 80 20 20 280 45 681
61570 41 11 25 190 33 585.5
61571 43 13 25 214 35 635.5
61575 49 16 25 298 39 762.5
61576 125 0 0 360 50 915
61580 180.4 0 0 280.9 84 1078.3
61581 168.4 0 0 360 118 1214.4
61582 153.3 0 0 298 95 1010.3
61583 180 0 0 307.4 50 906.4
61584 121.6 0 0 249.8 47 842.4
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
61585 166.7 0 0 340 57 1101.7
61586 120 0 0 270 40 720
61590 221.1 0 0 442.3 87 1418.4
61591 213 0 0 496.85 71 1254.85
61592 155.7 0 0 313.1 53 1002.8
61595 120 0 0 348.8 76 1077.8
61596 204.2 0 0 402.1 67 1188.3
61597 167.8 0 0 365.6 47 1041.4
61598 153.4 0 0 377.7 62 1048.1
61600 203.1 0 0 287.3 88 1101.4
61601 124.8 0 0 218.1 51 854.9
61605 225.3 0 0 285.3 84 1052.6
61606 139.5 0 0 269.4 50 926.9
61607 245.4 0 0 296.8 56 1201.2
61608 180 0 0 300 46 1042
61610 0 0 0 180 0 180
61611 0 0 0 120 0 120
61612 0 0 0 255 0 255
61613 180 0 0 300 46 1102
61615 195.3 0 0 344.9 65 1092.2
61616 157 0 0 401.8 76 1116.8
61618 120.5 0 0 148.6 61 573.1
61619 121.3 0 0 178.3 47 587.6
61623 50 0 0 90 45 185
61624 60 15 20 232 35 362
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
61626 60 15 20 173 35 303
61630 30 15 20 140 45 394
61635 30 15 20 150 45 424
61640 40 3 15 90 30 233
61641 30 30
61642 45 45
61645 40 3 15 100 83 241
61650 33 3 5 90 75 206
61651 45 45
61680 105 0 0 240 40 632
61682 120 0 0 420 50 874
61684 120 0 0 300 50 717
61686 135 0 0 420 55 1019
61690 101 0 0 240 53 672
61692 115 0 0 340 68 896
61697 60 30 15 300 50 1194
61698 60 40 15 360 50 1209
61700 60 30 15 240 40 949
61702 60 40 15 280 50 1144
61703 30 8 25 81 29 377
61705 47 14 25 246 38 655.5
61708 46 14 25 239 38 647.5
61710 42 12 25 182 36 551
61711 47 14 25 256 38 665.5
61720 105 0 0 120 35 384
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
61735 39 11 25 184 32 576.5
61750 35 10 25 133 30 487
61751 128 0 0 90 30 395
61760 128 0 0 200 30 505
61770 36 10 25 140 32 517
61781 15 0 0 30 0 45
61782 15 0 0 25 0 40
61783 15 0 0 30 0 45
61790 35 9 25 82 27 282
61791 35 8 25 119 27 328
61796 18 1 6 90 15 195
61797 0 0 0 30 0 30
61798 18 1 6 120 15 225
61799 0 0 0 60 0 60
61800 10 1 0 20 10 41
61850 27 6 25 73 23 306.5
61860 31 8 25 100 27 405
61863 45 15 15 140 30 452
61864 0 0 0 68 0 68
61867 50 15 15 300 30 617
61868 0 0 0 120 0 120
61870 33 8 25 118 28 426
61880 22 0 25 46 18 213.5
61885 33 3 15 45 20 181
61886 50 0 0 100 25 385
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
61888 20 0 25 34 18 171
62000 31 8 25 103 27 408
62005 36 9 25 147 29 470
62010 41 6 25 182 30 519.5
62100 43 7 25 227 32 549.5
62115 100 0 0 330 28 678
62117 108 0 0 300 30 714
62120 120 0 0 180 33 523
62121 39 11 25 166 31 496
62140 32 8 25 137 27 383
62141 32 6 25 147 29 413
62142 29 7 25 85 24 324
62143 33 8 25 115 26 371
62145 40 11 25 189 31 490
62146 35 9 25 131 28 402
62147 38 10 25 167 29 473
62148 0 0 0 30 0 30
62160 0 0 0 40 0 40
62161 85 0 0 90 45 400
62162 108 0 0 148 40 516
62163 78 0 0 90 30 358
62164 90 0 0 165 40 571
62165 85 0 0 180 45 490
62180 125 0 0 165 53 564
62190 31 7 25 103 25 355
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
62192 30 7 25 101 24 351
62194 80 0 0 75 35 294
62200 81 0 0 120 43 388
62201 143 0 0 75 60 425
62220 31 7 25 104 25 356
62223 90 0 0 90 30 357
62225 22 0 25 41 20 230.5
62230 26 6 25 72 22 293.5
62252 15 0 0 20 10 45
62256 22 0 25 44 20 233.5
62258 32 7 25 113 25 366
62263 33 10 5 45 40 214
62264 40 0 0 30 20 109
62267 14 10 10 30 15 79
62268 25 0 15 49 16 105
62269 25 0 15 50 19 109
62270 0 5 5 20 10 40
62272 9 0 0 19 8 36
62273 13 0 0 18 9 40
62280 14 0 0 32 11 57
62281 50 0 0 40 30 120
62282 14 0 0 27 11 52
62284 13 5 6 15 10 49
62287 70 0 0 60 30 248
62290 17 0 0 35 10 62
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
62291 18 0 0 37 11 66
62292 23 0 0 47 20 284
62294 33 8 0 117 24 336
62302 13 5 6 26 10 60
62303 13 5 6 25 10 59
62304 13 5 6 25 10 59
62305 13 6 6 30 10 65
62310 35 0 0 30 20 85
62311 35 0 0 20 15 70
62318 50 0 0 40 30 120
62319 48 0 0 30 30 108
62320 10 3 5 15 10 43
62321 10 5 5 15 10 45
62322 10 3 5 11 10 39
62323 10 5 5 15 10 45
62324 10 3 5 15 10 43
62325 10 5 5 15 10 45
62326 10 3 5 15 10 43
62327 10 5 5 15 10 45
62350 33 10 5 60 20 170
62351 62 0 0 90 30 449
62355 33 10 5 30 20 140
62360 33 10 5 60 20 170
62361 33 10 5 60 20 170
62362 33 10 5 60 20 170
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
62365 33 10 5 45 20 155
62367 5 0 0 10 5 20
62368 7 0 0 15 5 27
62369 7 0 0 15 5 27
62370 7 0 0 20 10 37
62380 33 18 15 70 30 231
63001 34 12 25 127 26 488
63003 34 9 25 127 26 485
63005 85 0 0 143 35 450
63011 34 9 25 126 26 415.5
63012 35 9 25 140 27 441.5
63015 90 0 0 150 38 465
63016 38 11 25 162 29 665.5
63017 90 0 0 150 30 437
63020 90 0 0 120 35 412
63030 75 0 0 90 30 342
63035 0 0 0 49 0 49
63040 38 10 25 162 29 479.5
63042 83 0 0 120 30 400
63043 0 0 0 0 0 0
63044 0 0 0 0 0 0
63045 40 18 20 120 30 395
63046 40 18 20 120 30 395
63047 40 15 20 90 30 362
63048 0 0 0 45 0 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
63050 55 25 15 150 30 455
63051 55 25 15 190 30 495
63055 40 12 25 187 31 520.5
63056 39 11 25 170 30 490.5
63057 0 0 0 47 0 47
63064 42 13 25 241 36 592.5
63066 0 0 0 51 0 51
63075 60 20 15 90 30 355
63076 0 0 0 63 0 63
63077 42 12 25 202 31 517.5
63078 0 0 0 51 0 51
63081 40 11 25 175 31 622.5
63082 0 0 0 68 0 68
63085 43 19 25 233 31 721.5
63086 0 0 0 50 0 50
63087 105 0 0 265 45 682
63088 0 0 0 67 0 67
63090 44 14 25 232 34 741
63091 0 0 0 47 0 47
63101 130 0 0 215 43 671
63102 130 0 0 205 40 658
63103 0 0 0 60 0 60
63170 39 11 25 178 30 623.5
63172 39 6 25 173 29 581
63173 40 11 25 194 30 630.5
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
63180 38 10 25 159 29 581.5
63182 41 12 25 198 30 636.5
63185 35 6 25 149 31 451.5
63190 39 8 25 186 28 491.5
63191 39 10 25 170 29 468.5
63194 38 10 25 155 29 662.5
63195 39 8 25 167 27 670
63196 41 11 25 180 31 703.5
63197 41 11 25 185 30 707.5
63198 42 13 25 223 33 983
63199 44 14 25 255 34 1029
63200 38 11 25 165 30 589.5
63250 53 13 25 367 33 941.5
63251 53 18 25 356 39 983
63252 53 18 25 354 39 981
63265 40 11 25 186 30 612.5
63266 43 11 25 186 31 636.5
63267 37 6 25 165 32 480.5
63268 39 11 25 179 29 498.5
63270 44 13 25 236 33 781.5
63271 44 13 25 234 33 779.5
63272 43 13 25 219 33 648.5
63273 43 13 25 220 32 648.5
63275 43 13 25 226 32 654.5
63276 42 10 25 226 31 659.5
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
63277 41 12 25 211 30 544.5
63278 41 12 25 213 30 546.5
63280 47 14 25 272 34 669
63281 47 14 25 272 34 669
63282 46 14 25 258 33 623
63283 45 13 25 255 33 618
63285 52 17 25 333 38 762
63286 51 17 25 330 37 747
63287 51 17 25 318 38 931
63290 52 17 25 336 38 960
63295 10 0 0 45 0 55
63300 40 12 25 190 31 638.5
63301 46 14 25 269 34 950
63302 47 15 25 277 35 871
63303 37 19 25 259 29 809.5
63304 44 14 25 231 34 845
63305 47 15 25 285 35 1004
63306 47 15 25 276 36 871
63307 47 15 25 269 35 863
63308 0 0 0 0 0 96
63600 34 13 25 101 27 364
63610 22 9 25 88 17 161
63615 34 8 25 118 26 365
63620 18 1 6 90 15 195
63621 0 0 0 60 0 60
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
63650 33 10 5 60 20 170
63655 33 15 15 90 20 254
63661 33 10 5 55 20 165
63662 33 15 15 60 20 243
63663 33 10 5 90 20 200
63664 33 15 15 90 20 273
63685 33 10 5 60 20 170
63688 33 10 5 55 20 165
63700 90 0 0 120 120 497
63702 90 0 0 180 130 567
63704 112 0 0 180 150 732
63706 120 0 0 240 150 800
63707 32 0 25 97 28 377.5
63709 35 9 25 146 26 426.5
63710 34 9 25 128 26 407.5
63740 31 8 25 116 23 378.5
63741 28 6 25 86 20 289
63744 26 5 25 75 19 282.5
63746 24 0 25 45 18 254.5
64400 16 0 0 37 16 69
64402 13 0 0 20 13 46
64405 7 0 0 5 10 22
64408 10 0 0 16 10 36
64410 10 0 0 17 11 38
64413 12 0 0 19 12 43
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
64415 13 1 5 15 10 44
64416 19 1 5 20 15 60
64417 13 0 0 19 13 45
64418 13 0 0 18 13 44
64420 10 0 0 17 10 37
64421 15 0 0 35 15 65
64425 8 0 0 15 8 31
64430 11 0 0 17 11 39
64435 8 0 0 17 8 33
64445 13 5 5 15 10 48
64446 19 5 5 20 15 64
64447 13 1 5 15 10 44
64448 19 1 5 15 15 55
64449 19 5 5 20 11 60
64450 10 0 0 5 5 20
64455 10 0 0 5 5 20
64461 13 1 5 15 10 44
64462 15 15
64463 13 1 5 20 15 54
64479 13 5 6 15 10 49
64480 0 0 0 15 0 15
64483 13 5 6 15 10 49
64484 0 0 0 10 0 10
64486 5 5 5 10 10 35
64487 5 5 5 15 10 40
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
64488 5 5 5 15 10 40
64489 5 5 5 20 10 45
64490 7 5 5 15 10 42
64491 0 0 0 15 0 15
64492 0 0 0 15 0 15
64493 7 5 5 15 10 42
64494 0 0 0 15 0 15
64495 0 0 0 15 0 15
64505 8 0 0 16 8 32
64508 11 0 0 10 15 36
64510 10 0 0 12 10 32
64517 10 10 10 25 20 75
64520 11 0 0 24 11 46
64530 10 0 0 30 9 49
64550 0 0 0 13 0 13
64553 13 1 6 75 18 155
64555 13 1 6 60 18 140
64561 22 5 0 45 19 131
64565 10 0 0 26 10 62
64566 7 10 5 22
64568 33 3 15 90 30 275
64569 40 3 15 120 30 312
64570 40 3 15 90 30 282
64575 12 0 0 30 12 78
64580 11 0 0 33 11 79
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
64581 60 0 0 120 30 269
64585 9 0 0 24 9 58
64590 12 0 0 34 12 74
64595 10 0 0 30 10 66
64600 16 0 0 29 16 77
64605 22 0 0 47 18 103
64610 24 0 25 56 19 140
64611 10 0 0 5 5 36
64612 10 0 0 10 5 41
64615 15 0 0 15 5 35
64616 10 5 0 15 5 35
64617 15 1 0 15 5 36
64620 16 0 0 29 15 76
64630 17 0 0 30 15 78
64632 10 0 0 5 5 36
64633 18 5 6 30 15 116
64634 0 0 0 20 0 20
64635 18 5 6 28 15 114
64636 0 0 0 15 0 15
64640 10 0 0 5 5 36
64642 10 5 0 20 5 40
64643 0 1 0 20 0 21
64644 10 5 0 25 5 45
64645 0 1 0 25 0 26
64646 10 5 0 20 5 40
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
64647 10 5 0 25 5 45
64650 5 2 0 23 5 35
64653 5 2 0 23 5 35
64680 20 0 0 46 16 98
64681 13 10 9 30 20 122
64702 20 15 10 50 20 212
64704 19 0 15 61 17 152
64708 35 10 10 60 15 220
64712 25 0 25 109 19 245
64713 33 0 25 213 24 429
64714 33 0 25 178 24 364
64716 30 0 0 60 30 182
64718 23 0 25 73 18 250
64719 20 0 15 56 18 149
64721 20 15 10 25 20 171
64722 20 0 15 48 17 159
64726 18 0 15 52 15 151
64727 0 0 0 72 0 72
64732 18 0 15 30 16 132.5
64734 28 0 15 38 21 186
64736 19 0 15 42 17 139
64738 22 0 15 52 19 173
64740 21 0 15 47 18 166
64742 23 0 15 57 19 179
64744 26 0 25 51 18 192.5
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
64746 22 0 25 47 18 177
64755 30 0 0 83 15 360
64760 25 0 25 60 18 212
64763 25 0 25 74 21 210
64766 28 0 25 88 22 239.5
64771 26 0 25 88 21 236.5
64772 27 0 25 89 20 245
64774 21 0 25 47 16 174
64776 21 0 25 43 16 158.5
64778 0 0 0 0 0 29
64782 29 0 15 85 22 235
64783 0 0 0 0 0 44
64784 29 0 25 105 22 257.5
64786 31 0 25 135 24 291.5
64787 0 0 0 0 0 52
64788 22 0 25 53 18 183
64790 34 0 25 171 25 331.5
64792 39 0 25 218 27 416
64795 20 0 15 38 18 91
64802 29 0 25 112 23 354.5
64804 32 0 25 132 25 389.5
64809 30 0 25 103 24 336
64818 36 0 25 110 20 345
64820 55 0 0 90 70 268
64821 50 0 0 60 30 269
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
64822 50 0 0 60 30 269
64823 50 0 0 90 30 299
64831 40 10 15 60 15 237
64832 0 0 0 74 0 74
64834 26 0 25 69 22 226
64835 29 0 25 86 24 259.5
64836 29 0 25 87 24 260.5
64837 0 0 0 80 0 80
64840 34 0 25 153 27 356
64856 32 0 25 157 26 415.5
64857 35 0 25 157 26 428.5
64858 36 0 25 169 27 442.5
64859 0 0 0 71 0 71
64861 40 0 25 227 30 549
64862 39 0 25 210 30 531
64864 26 0 25 126 20 321
64865 39 0 25 171 25 365.5
64866 36 0 25 158 27 391.5
64868 27 0 25 154 21 351
64872 0 0 0 30 0 30
64874 0 0 0 45 0 45
64876 0 0 0 51 0 51
64885 60 0 0 151 30 325
64886 60 0 0 177 30 411
64890 36 0 25 171 26 403.5
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
64891 37 0 25 170 27 424.5
64892 36 0 25 164 26 396.5
64893 37 0 25 174 28 439.5
64895 40 0 25 210 28 458.5
64896 41 0 25 231 29 523
64897 41 0 25 230 29 480.5
64898 42 0 25 237 30 531
64901 0 0 0 165 0 165
64902 0 0 0 184 0 184
64905 36 0 25 150 27 383.5
64907 36 0 25 150 28 404.5
64910 25 10 15 90 20 264
64911 25 10 15 120 20 294
64999 0 0 0 0 0 0
65091 20 0 15 38 15 164.5
65093 26 0 25 52 17 214
65101 21 0 25 56 19 232
65103 21 0 25 61 19 237
65105 24 0 25 77 21 269.5
65110 32 0 25 122 27 370.5
65112 36 0 25 145 31 434.5
65114 37 0 25 155 32 446.5
65125 30 0 0 40 30 148
65130 22 0 15 52 19 200
65135 23 0 15 57 20 207
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
65140 25 0 15 72 21 255.5
65150 18 0 15 66 13 187
65155 26 0 15 94 21 259.5
65175 20 0 15 42 17 174.5
65205 5 0 0 5 5 15
65210 6 0 0 13 6 25
65220 5 0 0 8 5 18
65222 5 0 0 7 3 15
65235 23 0 0 41 18 185.5
65260 28 0 15 69 24 270
65265 31 0 15 93 26 291.5
65270 12 0 0 27 12 67
65272 14 0 0 32 12 115.5
65273 15 0 0 41 13 164.5
65275 18 0 0 44 15 146
65280 24 0 15 68 20 249.5
65285 30 10 20 90 30 353
65286 19 0 15 42 16 172.5
65290 19 0 15 47 17 178.5
65400 20 0 0 45 21 189.5
65410 12 0 0 21 12 45
65420 18 0 15 31 21 149
65426 5 5 10 47.5 12 162.5
65430 10 0 0 10 8 28
65435 9 0 0 14 9 32
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
65436 14 0 0 27 14 101
65450 17 0 0 20 16 117
65600 14 0 0 30 14 115.5
65710 35 0 0 90 20 317
65730 40 0 0 90 20 322
65750 40 0 0 90 20 288
65755 40 0 0 90 20 288
65756 33 1 5 60 20 255
65757 0 0 0 15 0 15
65760 45 0 0 53 85 183
65765 60 0 0 60 85 205
65767 53 0 0 60 70 183
65770 37 0 25 153 34 456.5
65771 0 0 0 0 0 195
65772 15 0 15 28 13 128.5
65775 19 0 15 38 16 168.5
65778 17 1 5 5 5 33
65779 19 1 5 30 10 65
65780 19 1 5 50 10 230
65781 60 0 0 90 25 354
65782 60 0 0 83 25 331
65785 15 3 5 30 10 134
65800 12 1 5 5 5 28
65810 16 0 15 28 14 142
65815 17 0 15 37 14 152
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
65820 60 0 0 60 30 244
65850 15 10 12.5 60 17.5 233
65855 17 1 2 10 15 61
65860 45 0 0 44 15 120
65865 19 0 15 33 12 135
65870 20 0 15 33 17 165.5
65875 21 0 15 33 17 178
65880 22 0 15 38 18 185
65900 27 0 15 68 21 246
65920 15 0 15 51 18 214
65930 18 0 15 40 15 176
66020 11 0 0 14 11 52
66030 10 0 0 15 10 51
66130 14 0 15 40 14 131
66150 20 0 15 53 20 269
66155 20 0 15 49 20 284
66160 18 0 15 52 20 266
66170 19 1 5 45 10 278
66172 19 1 5 60 10 325
66174 10 1 5 60 10 215
66175 10 1 5 67.5 10 222.5
66179 19 1 5 55 10 272
66180 19 1 5 60 10 277
66183 10 5 5 45 10 257
66184 19 1 5 60 10 254
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
66185 19 1 5 65 10 259
66220 23 0 15 38 19 198.5
66225 29 0 15 112 23 294
66250 19 0 15 45 16 175.5
66500 19 0 15 18 11 103
66505 15 0 15 17 13 108
66600 24 0 15 50 19 211.5
66605 24 0 15 59 20 221.5
66625 16 0 15 30 15 132
66630 19 0 15 41 16 171.5
66635 20 0 15 36 16 167.5
66680 16 0 15 45 14 159
66682 20 0 15 38 16 169.5
66700 45 0 0 47 15 146
66710 45 0 0 41 15 140
66711 10 5 10 30 10 192
66720 10 0 15 32 17 146
66740 45 0 0 41 15 140
66761 7 0 0 10 10 66
66762 14 0 15 25 12 123.5
66770 15 0 15 20 13 132
66820 21 0 15 25 12 113
66821 15 0 0 11 10 82
66825 45 0 0 60 20 219
66830 23 0 15 43 16 189
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
66840 22 0 15 36 18 183
66850 25 0 15 44 20 207.5
66852 22 0 15 48 18 206.5
66920 23 0 15 41 17 188
66930 25 0 15 47 20 210.5
66940 23 0 15 41 16 198.5
66982 19 1 5 33 10 165
66983 22 0 15 52 15 207.5
66984 16 1 5 21 7 147
66985 33 0 15 40 24 227
66986 45 5 10 90 110 260
66990 0 0 0 20 0 20
66999 0 0 0 0 0 0
67005 20 0 15 36 12 147
67010 20 0 15 45 12 156
67015 21 0 15 48 15 171
67025 22 0 15 42 19 190
67027 60 0 0 60 30 244
67028 6 1 5 5 5 22
67030 21 0 0 37 17 167
67031 14 0 0 26 12 109.5
67036 33 3 15 50 15 250
67039 33 3 15 60 15 260
67040 33 3 15 73 15 273
67041 33 3 15 60 15 260
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
67042 33 3 15 60 15 260
67043 33 3 15 75 15 275
67101 19 1 5 40 15 145
67105 5 1 5 30 10 97
67107 33 3 15 90 15 290
67108 33 3 15 90 20 295
67110 12 1 5 30 10 196
67113 33 3 15 120 20 348
67115 19 0 15 28 16 158.5
67120 19 0 15 32 16 162.5
67121 28 0 15 100 22 280
67141 28 0 0 32 10 139
67145 24 0 0 25 11 129
67208 17 0 0 36 15 137
67210 10 5 2 15 5 106
67218 90 0 0 60 30 464
67220 15 5 3.5 15 10 117.5
67221 10 0 0 15 5 30
67225 0 0 0 3 0 3
67227 5 1 5 30 10 93
67228 17 1 5 25 10 81
67229 15 15 15 75 17.5 353.5
67250 22 0 25 79 15 210
67255 19 1 5 45 10 216
67299 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
67311 25 0 15 35 18 173.5
67312 19 0 15 54 22 190.5
67314 19 0 15 40 16 182
67316 21 0 15 62 18 208
67318 20 0 15 43 17 187
67320 22 0 15 54 18 201
67331 21 0 15 57 17 202
67332 22 0 15 71 18 218
67334 21 0 15 47 17 192
67335 0 0 0 52 0 52
67340 24 0 15 81 19 231
67343 19 0 15 37 16 167.5
67345 9 0 15 10 8 58
67346 17 0 15 27 15 74
67399 0 0 0 0 0 0
67400 26 0 25 59 23 255.5
67405 22 0 25 30 21 209
67412 25 0 15 104 14 234.5
67413 27 0 15 76 22 220
67414 15 10 15 120 30 347
67415 11 0 15 14 11 51
67420 60 0 0 180 35 468
67430 33 0 15 142 25 353
67440 33 0 25 105 28 336.5
67445 15 15 15 120 30 352
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
67450 33 0 25 124 27 366
67500 5 5 5 5 5 25
67505 10 5 5 10 5 35
67515 6 5 0 5 5 21
67550 29 0 15 100 23 282
67560 28 0 15 96 22 276
67570 45 0 0 124 30 294
67599 0 0 0 0 0 0
67700 11 0 0 21 11 59
67710 6 0 0 11 6 39
67715 7 0 0 11 7 41
67800 13 0 0 19 6 46
67801 8 0 0 26 6 48
67805 9 0 0 44 9 78
67808 13 0 15 29 12 126.5
67810 8 1 2 13 3 27
67820 5 2 1 5 2 15
67825 8 0 0 15 8 47
67830 9 0 0 22 9 56
67835 18 0 15 58 15 154
67840 5 5 5 15 10 56
67850 7 0 0 18 7 48
67875 10 0 0 20 9 39
67880 14 0 0 31 12 114.5
67882 17 0 15 41 14 156
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
67900 30 0 0 70 15 177
67901 10 10 10 60 15 188
67902 10 10 13 78 20 221
67903 22 0 15 42 18 145
67904 10 10 15 45 15 185
67906 22 0 15 31 18 134
67908 18 0 15 30 17 136
67909 19 0 15 30 16 136
67911 10 10 15 50 15 183
67912 15 5 10 40 15 166
67914 19 1 5 20 10 129
67915 17 1 5 10 5 70
67916 19 1 5 25 10 134
67917 19 1 5 33 10 142
67921 19 1 5 15 10 124
67922 17 1 5 10 10 75
67923 19 1 5 25 10 134
67924 19 1 5 40 10 149
67930 13 0 0 35 13 77
67935 18 0 15 54 15 150
67938 8 0 0 16 8 48
67950 18 0 15 40 15 144
67961 22 0 15 56 18 167
67966 10 10 15 60 15 200
67971 25 0 15 103 20 235
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
67973 29 0 15 98 23 253
67974 29 0 15 100 23 255
67975 24 0 15 67 19 197
67999 0 0 0 0 0 0
68020 7 0 0 11 7 41
68040 5 0 0 6 5 16
68100 9 0 0 16 9 34
68110 10 0 0 22 10 58
68115 14 0 0 26 12 68
68130 17 0 0 44 15 132
68135 12 0 0 20 10 58
68200 3 0 0 5 3 11
68320 22 0 15 67 13 209
68325 22 0 15 70 18 217
68326 22 0 15 64 18 211
68328 24 0 15 81 19 231
68330 16 0 15 40 14 154
68335 22 0 15 69 18 216
68340 15 0 15 34 13 134.5
68360 15 0 15 38 13 138.5
68362 22 0 15 56 18 203
68371 30 0 0 20 17 150
68399 0 0 0 0 0 0
68400 9 0 0 22 9 56
68420 14 0 0 22 9 61
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
68440 6 0 0 7 6 35
68500 28 0 15 69 22 260.5
68505 28 0 15 71 22 262.5
68510 20 0 15 29 14 78
68520 23 0 15 64 18 212
68525 21 0 15 41 17 94
68530 18 0 0 40 15 89
68540 28 0 15 83 22 263
68550 32 0 15 118 25 328
68700 21 0 15 54 19 201
68705 6 0 15 12 6 55
68720 40 0 0 90 20 235
68745 23 0 15 63 19 212
68750 25 0 15 70 20 233.5
68760 6 0 0 9 6 37
68761 5 0 0 17 0 38
68770 22 0 0 49 18 181
68801 3 2 2 5 5 33
68810 5 2 5 10 5 43
68811 19 1 5 10 13.5 74.5
68815 19 1 5 20 12 108
68816 19 1 5 20 12 83
68840 5 3 0 10 5 39
68850 7 0 0 12 7 26
68899 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
69000 7 0 0 19 7 49
69005 10 0 0 27 9 62
69020 6 0 0 12 6 40
69090 0 0 0 0 0 0
69100 7 0 0 12 5 24
69105 7 0 0 12 6 25
69110 12 0 0 37 10 91
69120 14 0 0 52 11 109
69140 20 0 0 73 17 185
69145 10 0 0 29 9 72
69150 27 0 25 111 20 285
69155 90 0 0 285 30 745
69200 5 5 0 10 3 23
69205 7 0 0 9 6 25.5
69209 0 0 0 0 0 0
69210 3 2 0 10 2 17
69220 5 1 0 10 2 18
69222 8 0 0 17 7 48
69300 25 0 0 120 35 227
69310 25 0 15 97 19 220
69320 33 0 15 188 24 359
69399 0 0 0 0 0 0
69420 5 0 0 11 5 37
69421 7 0 0 9 6 38
69424 6 0 0 7 6 19
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
69433 12 2 5 9 5 56
69436 15 0 15 9 9 64
69440 21 0 15 62 20 185
69450 17 0 15 31 13 116
69501 23 0 25 74 17 206
69502 27 0 25 125 20 299
69505 28 0 25 146 20 321
69511 28 0 25 143 20 318
69530 34 0 25 218 26 563
69535 36 0 25 380 31 770
69540 7 0 0 14 6 43
69550 24 0 25 91 19 234
69552 32 0 25 184 23 396
69554 120 0 0 480 60 1024
69601 32 0 25 139 24 330
69602 28 0 25 149 21 325
69603 28 0 25 143 21 319
69604 28 0 25 160 21 336
69605 33 0 25 218 23 409
69610 17 0 0 43 14 90
69620 21 0 15 52 22 158
69631 24 0 15 104 19 245
69632 24 0 15 129 15 274
69633 27 0 15 122 20 275
69635 29 0 25 134 21 292
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
69636 31 0 25 163 22 332
69637 31 0 25 171 22 340
69641 25 0 25 175 14 341
69642 26 0 25 192 15 376
69643 30 0 25 172 22 369
69644 32 0 25 199 23 399
69645 31 0 25 168 23 377
69646 33 0 25 194 24 416
69650 21 0 25 51 17 181
69660 24 0 25 72 14 202
69661 28 0 25 99 22 276
69662 26 0 25 83 21 249
69666 21 0 25 57 17 206
69667 21 0 25 57 17 206
69670 26 0 25 105 20 280
69676 21 0 25 58 17 196
69700 21 0 15 61 17 181
69710 0 0 0 0 0 0
69711 26 0 0 121 19 249
69714 55 0 0 90 30 284
69715 58 0 0 155 30 359
69717 50 0 0 95 28 282
69718 53 0 0 175 30 374
69720 32 0 25 148 22 357
69725 105 0 0 275 45 695
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
69740 37 0 25 170 26 374
69745 41 0 25 218 27 435
69799 0 0 0 0 0 0
69801 12 1 5 15 10 43
69805 60 0 0 120 30 347
69806 29 0 25 120 21 309
69820 25 0 0 98 19 206
69840 24 0 15 90 18 211
69905 23 0 25 73 18 233
69910 26 0 25 130 20 315
69915 35 0 25 174 32 573
69930 60 15 20 180 30 387
69949 0 0 0 0 0 0
69950 120 0 0 210 45 669
69955 120 0 0 300 45 755
69960 100 0 0 240 45 675
69970 120 0 0 330 53 793
69979 0 0 0 0 0 0
69990 0 0 0 40 0 40
70010 0 0 0 0 0 23
70015 0 0 0 0 0 23
70030 0 0 0 0 0 5
70100 0 0 0 0 0 5
70110 0 0 0 0 0 7
70120 0 0 0 0 0 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
70130 0 0 0 0 0 8
70134 0 0 0 0 0 8
70140 0 0 0 0 0 6
70150 0 0 0 0 0 7
70160 0 0 0 0 0 5
70170 0 0 0 0 0 8
70190 0 0 0 0 0 6
70200 0 0 0 0 0 7
70210 0 0 0 0 0 5
70220 0 0 0 0 0 7
70240 0 0 0 0 0 6
70250 0 0 0 0 0 7
70260 0 0 0 7 0 7
70300 0 0 0 0 0 4
70310 0 0 0 0 0 5
70320 0 0 0 0 0 6
70328 0 0 0 0 0 5
70330 0 0 0 22 0 22
70332 0 0 0 0 0 12
70336 0 0 0 20 0 20
70350 0 0 0 0 0 5
70355 0 0 0 5 1 6
70360 0 0 0 0 0 5
70370 0 0 0 0 0 8
70371 0 0 0 0 0 17
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
70380 0 0 0 0 0 5
70390 0 0 0 0 0 9
70450 4 0 0 10 5 19
70460 5 0 0 12 5 22
70470 5 0 0 15 5 25
70480 0 0 0 0 0 25
70481 0 0 0 0 0 26
70482 0 0 0 0 0 27
70486 3 0 0 10 3 16
70487 5 0 0 12 5 22
70488 5 0 0 15 5 25
70490 0 0 0 0 0 25
70491 0 0 0 0 0 26
70492 0 0 0 0 0 27
70496 5 0 0 20 5 30
70498 5 0 0 20 5 30
70540 5 19 5 29
70542 5 20 5 30
70543 5 25 5 35
70544 5 0 0 10 10 25
70545 5 0 0 15 10 30
70546 6 0 0 15 10 31
70547 5 0 0 10 10 25
70548 10 0 0 15 10 35
70549 10 0 0 20 10 40
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
70551 5 0 0 18 5 28
70552 5 0 0 20 7 32
70553 5 0 0 25 7 37
70554 15 0 0 35 10 60
70555 10 0 0 45 10 65
70557 30 0 0 120 15 165
70558 30 0 0 120 15 165
70559 30 0 0 120 15 165
71010 1 0 0 3 1 5
71015 0 0 0 0 0 6
71020 1 0 0 3 1 5
71021 0 0 0 0 0 7
71022 0 0 0 0 0 8
71023 0 0 0 0 0 9
71030 0 0 0 0 0 8
71034 0 0 0 0 0 10
71035 0 0 0 0 0 5
71100 1 0 0 4 1 6
71101 0 0 0 0 0 7
71110 0 0 0 0 0 7
71111 0 0 0 5 0 5
71120 0 0 0 0 0 6
71130 0 0 0 0 0 6
71250 5 0 0 15 5 25
71260 3 0 0 15 5 23
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
71270 0 0 0 0 0 26
71275 5 0 0 25 5 35
71550 0 0 0 0 0 30
71551 10 0 0 25 10 45
71552 7.5 0 0 24 10 41.5
71555 5 0 0 30 8 43
72020 0 0 0 0 0 5
72040 1 0 0 3 2 6
72050 1 0 0 5 2 8
72052 1 0 0 5 2 8
72070 1 0 0 3 1 5
72072 0 0 0 0 0 6
72074 0 0 0 0 0 6
72080 0 0 0 0 0 6
72081 1 5 1 7
72082 1 6 1 8
72083 1 7 1 9
72084 1 8 1 10
72100 1 0 0 3 2 6
72110 1 0 0 5 2 8
72114 1 0 0 5 2 8
72120 1 0 0 3 2 6
72125 5 0 0 15 5 25
72126 0 0 0 0 0 23
72127 0 0 0 0 0 24
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
72128 5 0 0 15 5 25
72129 0 0 0 0 0 23
72130 0 0 0 0 0 24
72131 5 0 0 15 5 25
72132 0 0 0 0 0 23
72133 0 0 0 0 0 24
72141 5 0 0 20 5 30
72142 5 0 0 23 5 33
72146 5 0 0 20 5 30
72147 5 0 0 23 5 33
72148 5 0 0 20 5 30
72149 5 0 0 23 5 33
72156 5 0 0 25 5 35
72157 5 0 0 25 5 35
72158 5 0 0 25 5 35
72159 5 0 0 28 8 41
72170 1 4 2 7
72190 0 0 0 0 0 6
72191 5 0 0 25 5 35
72192 3 0 0 10 5 18
72193 3 0 0 10 5 18
72194 0 0 0 0 0 23
72195 0 0 0 30 0 30
72196 12.5 0 0 20 10 42.5
72197 10 0 0 25 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
72198 5 0 0 25 8 38
72200 0 0 0 0 0 5
72202 0 0 0 0 0 6
72220 0 0 0 0 0 5
72240 5 0 0 16 5 26
72255 5 0 0 15 5 25
72265 5 0 0 15 5 25
72270 5 0 0 20 5 30
72275 12.5 0 0 30 2 44.5
72285 0 0 0 0 0 17
72295 0 0 0 0 0 17
73000 0 0 0 0 0 5
73010 0 0 0 0 0 5
73020 0 0 0 0 0 5
73030 1 0 0 4 2 7
73040 0 0 0 0 0 12
73050 0 0 0 0 0 6
73060 1 0 0 3 1 5
73070 0 0 0 0 0 5
73080 1 0 0 3 1 5
73085 0 0 0 0 0 12
73090 0 0 0 0 0 5
73092 0 0 0 0 0 5
73100 1 0 0 3 1 5
73110 1 0 0 3 1 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
73115 0 0 0 0 0 12
73120 1 0 0 3 1 5
73130 1 0 0 3 1 5
73140 1 0 0 2 1 4
73200 5 0 0 15 5 25
73201 0 0 0 0 0 22
73202 0 0 0 0 0 23
73206 10 0 0 30 10 50
73218 0 0 0 25 0 25
73219 10 0 0 20 10 40
73220 10 0 0 25 10 45
73221 5 0 0 20 5 30
73222 5 0 0 20 8 33
73223 10 0 0 30 10 50
73225 5 0 0 28 8 41
73501 1 3 1 5
73502 1 4 1 6
73503 1 5 1 7
73521 1 4 1 6
73522 1 5 1 7
73523 1 6 1 8
73525 0 0 0 0 0 12
73551 1 3 1 5
73552 1 4 1 6
73560 1 0 0 3 1 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
73562 1 0 0 4 1 6
73564 1 0 0 5 1 7
73565 1 0 0 3 1 5
73580 0 0 0 0 0 12
73590 1 0 0 3 1 5
73592 0 0 0 0 0 5
73600 1 0 0 3 1 5
73610 1 0 0 3 1 5
73615 0 0 0 0 0 12
73620 1 0 0 3 1 5
73630 1 0 0 3 1 5
73650 0 0 0 0 0 5
73660 0 0 0 0 0 5
73700 5 0 0 15 5 25
73701 0 0 0 0 0 22
73702 0 0 0 0 0 23
73706 10 0 0 30 10 50
73718 0 0 0 20 0 20
73719 10 0 0 20 10 40
73720 10 0 0 25 10 45
73721 5 0 0 20 5 30
73722 8.5 0 0 20 10 38.5
73723 10 0 0 26.5 10 46.5
73725 5 0 0 30 8 43
74000 1 0 0 3 1 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
74010 0 0 0 0 0 6
74020 1 0 0 3 1 5
74022 1 0 0 3 1 5
74150 3 0 0 12 5 20
74160 3 0 0 15 5 23
74170 5 0 0 18 5 28
74174 5 0 0 30 5 40
74175 5 0 0 25 5 35
74176 5 0 0 22 5 32
74177 5 0 0 25 5 35
74178 5 0 0 30 5 40
74181 0 0 0 0 0 30
74182 15 0 0 20 10 45
74183 10 0 0 30 10 50
74185 5 0 0 30 8 43
74190 2 0 0 28 2 32
74210 0 0 0 0 0 9
74220 0 0 0 0 0 10
74230 3 0 0 10 4 17
74235 0 0 0 0 0 23
74240 0 0 0 0 0 14
74241 0 0 0 0 0 14
74245 0 0 0 0 0 18
74246 0 0 0 0 0 14
74247 5 0 0 15 5 25
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
74249 0 0 0 0 0 18
74250 0 0 0 0 0 10
74251 2 0 0 32 4 38
74260 0 0 0 0 0 11
74261 5 0 0 40 5 50
74262 5 0 0 45 7 57
74263 7 0 0 38 5 50
74270 0 0 0 0 0 14
74280 5 0 0 20 7 32
74283 0 0 0 0 0 37
74290 0 0 0 0 0 8
74300 0 0 0 0 0 9
74301 0 0 0 0 0 6
74328 0 0 0 0 0 16
74329 0 0 0 0 0 15
74330 0 0 0 30 0 30
74340 2 0 0 30 2 34
74355 0 0 0 0 0 16
74360 0 0 0 0 0 12
74363 0 0 0 0 0 18
74400 5 0 0 15 5 25
74410 0 0 0 0 0 11
74415 0 0 0 0 0 11
74420 0 0 0 0 0 9
74425 0 0 0 0 0 9
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
74430 0 0 0 0 0 8
74440 0 0 0 0 0 9
74445 0 0 0 0 0 22
74450 0 0 0 0 0 8
74455 0 0 0 0 0 8
74470 0 0 0 0 0 12
74485 0 0 0 0 0 12
74710 0 0 0 0 0 8
74712 15 60 15 90
74713 35 35
74740 0 0 0 0 0 9
74742 0 0 0 0 0 13
74775 0 0 0 0 0 13
75557 10 0 0 40 10 60
75559 15 0 0 50 10 75
75561 10 0 0 45 10 65
75563 12.5 0 0 60 10 82.5
75565 0 0 0 10 0 10
75571 5 0 0 10 5 20
75572 10 0 0 20 10 40
75573 15 0 0 30 15 60
75574 10 0 0 30 10 50
75600 0 0 0 0 0 11
75605 0 0 0 0 0 22
75625 0 0 0 0 0 22
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
75630 0 0 0 0 0 25
75635 10.5 0 0 45 15 70.5
75658 0 0 0 0 0 25
75705 0 0 0 0 0 40
75710 0 0 0 0 0 22
75716 0 0 0 0 0 25
75726 0 0 0 0 0 22
75731 0 0 0 0 0 22
75733 0 0 0 0 0 25
75736 0 0 0 0 0 22
75741 0 0 0 0 0 25
75743 0 0 0 0 0 31
75746 0 0 0 0 0 22
75756 0 0 0 0 0 22
75774 0 0 0 0 0 9
75791 15 0 0 25 15 55
75801 0 0 0 0 0 16
75803 0 0 0 0 0 23
75805 0 0 0 0 0 16
75807 0 0 0 0 0 23
75809 0 0 0 0 0 10
75810 0 0 0 0 0 22
75820 0 0 0 0 0 14
75822 0 0 0 0 0 21
75825 0 0 0 0 0 22
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
75827 0 0 0 0 0 22
75831 0 0 0 0 0 22
75833 0 0 0 0 0 28
75840 0 0 0 0 0 22
75842 0 0 0 0 0 28
75860 0 0 0 0 0 22
75870 0 0 0 0 0 22
75872 0 0 0 0 0 22
75880 0 0 0 0 0 14
75885 0 0 0 0 0 27
75887 0 0 0 0 0 27
75889 0 0 0 0 0 22
75891 0 0 0 0 0 22
75893 0 0 0 0 0 12
75894 0 0 0 0 0 25
75898 0 0 0 0 0 31
75901 4 0 0 9 5 18
75902 5 0 0 10 5 20
75952 20 0 0 60 15 95
75953 20 0 0 45 30 95
75954 0 0 0 0 0 85
75956 30 0 0 90 20 140
75957 30 0 0 60 20 110
75958 30 0 0 60 20 110
75959 20 0 0 45 20 85
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
75962 0 0 0 0 0 12
75964 0 0 0 0 0 9
75966 0 0 0 0 0 25
75968 0 0 0 0 0 9
75970 0 0 0 0 0 17
75978 0 0 0 0 0 12
75984 0 0 0 0 0 15
75989 0 0 0 0 0 23
76000 0 0 0 0 0 5
76001 0 0 0 0 0 14
76010 0 0 0 0 0 5
76080 0 0 0 0 0 12
76098 0 0 0 0 0 5
76100 0 0 0 0 0 12
76101 0 0 0 0 0 12
76102 0 0 0 0 0 12
76120 0 0 0 0 0 9
76125 0 0 0 0 0 7
76140 0 0 0 0 0 0
76376 5 0 0 5 5 15
76377 5 0 0 17 8 30
76380 0 0 0 0 0 19
76390 0 0 0 28 0 28
76496 0 0 0 0 0 0
76497 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
76498 0 0 0 0 0 0
76499 0 0 0 0 0 0
76506 0 0 0 0 0 19
76510 5 0 0 30 10 45
76511 5 0 0 15 10 30
76512 10 0 0 15 10 35
76513 0 0 0 0 0 19
76514 5 0 0 5 5 15
76516 0 0 0 17 0 17
76519 5 7 0 5 0 17
76529 0 0 0 0 0 18
76536 4 0 0 10 4 18
76604 0 0 0 0 0 18
76641 5 0 0 12 5 22
76642 5 0 0 10 5 20
76700 5 0 0 11 5 21
76705 5 0 0 8 5 18
76706 5 10 5 20
76770 5 0 0 10 5 20
76775 5 0 0 8 5 18
76776 5 0 0 10 5 20
76800 0 0 0 0 0 28
76801 5 0 0 15 7 27
76802 0 0 0 10 0 10
76805 5 0 0 15 6 26
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
76810 0 0 0 20 0 20
76811 10 0 0 30 12 52
76812 0 0 0 25 0 25
76813 5 0 0 20 10 35
76814 0 0 0 20 0 20
76815 5 0 0 5.5 5 15.5
76816 6 0 0 15 10 31
76817 5 0 0 10 8 23
76818 10 0 0 30 8 48
76819 10 0 0 22.5 7 39.5
76820 5 0 0 10 5 20
76821 5 0 0 10 5 20
76825 10 0 0 40 20 70
76826 0 0 0 0 0 22
76827 0 0 0 0 0 18
76828 0 0 0 0 0 18
76830 5 0 0 10 8 23
76831 15 0 0 22 10 47
76856 5 0 0 10 5 20
76857 5 0 0 7 5 17
76870 0 0 0 0 0 19
76872 10 0 0 15 10 35
76873 20 0 0 30 10 60
76881 5 0 0 15 5 25
76882 5 0 0 11 5 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
76885 0 0 0 20 0 20
76886 0 0 0 15 0 15
76930 7 0 0 30 5 42
76932 7 0 0 32 5 44
76936 5 0 0 68 4 77
76937 0 0 0 10 4 14
76940 20 0 0 120 15 155
76941 0 0 0 68 0 68
76942 7 0 0 15 5 27
76945 0 0 0 30 0 30
76946 0 0 0 0 0 15
76948 25 25
76965 25 0 0 62 11 98
76970 0 0 0 0 0 15
76975 0 0 0 34 0 34
76977 0 0 0 5 0 5
76998 0 0 0 0 0 29
76999 0 0 0 0 0 0
77001 2 15 0 17
77002 2 15 0 17
77003 2 15 17
77011 0 0 0 0 0 23
77012 0 0 0 0 0 22
77013 20 0 0 120 15 155
77014 0 0 0 0 0 17
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
77021 20 0 0 42.5 15 77.5
77022 20 0 0 165 15 200
77051 0 0 0 1 0 1
77052 0 0 0 1 0 1
77053 0 0 0 0 0 9
77054 0 0 0 0 0 10
77055 4.5 0 0 7 8 19.5
77056 5 0 0 10 8 23
77057 2 0 0 5 5 12
77058 0 0 0 50 0 50
77059 0 0 0 55 0 55
77063 0 0 0 8 0 8
77065 0 0 0 0 0 0
77066 0 0 0 0 0 0
77067 0 0 0 0 0 0
77071 0 0 0 11 0 11
77072 0 0 0 0 0 6
77073 0 0 0 0 0 7
77074 0 0 0 0 0 10
77075 0 0 0 0 0 12
77076 3 0 0 10 5 18
77077 0 0 0 0 0 8
77078 0 0 0 0 0 7
77080 2 0 0 5 2 9
77081 5 0 0 5 10 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
77084 0 0 0 0 0 30
77085 3 0 0 8 3 14
77086 2 0 0 5 2 9
77261 0 0 0 0 0 43
77262 0 0 0 0 0 55
77263 0 0 0 75 0 75
77280 7 0 0 25 5 37
77285 7 0 0 40 5 52
77290 7 0 0 60 10 77
77293 0 0 0 45 0 45
77295 7 0 0 90 15 112
77299 0 0 0 0 0 0
77300 0 0 0 15 0 15
77301 30 0 0 130 35 195
77306 3 0 0 40 3 46
77307 3 0 0 80 3 86
77316 3 0 0 40 3 46
77317 3 0 0 50 3 56
77318 3 0 0 80 3 86
77321 0 0 0 0 0 35
77331 0 0 0 30 0 30
77332 15 3 18
77333 20 5 25
77334 30 5 35
77336 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
77338 0 0 0 115 0 115
77370 0 0 0 0 0 0
77371 0 0 0 0 0 0
77372 0 0 0 0 0 0
77373 0 0 0 0 0 0
77399 0 0 0 0 0 0
77401 0 0 0 0 0 0
77402 0 0 0 0 0 0
77407 0 0 0 0 0 0
77412 0 0 0 0 0 0
77417 0 0 0 0 0 0
77422 0 0 0 0 0 0
77423 0 0 0 0 0 0
77427 7 0 0 70 10 101.3900004
77431 0 0 0 0 0 50
77432 0 0 0 0 0 156
77435 20 0 0 210 20 250
77469 33 3 15 90 30 171
77470 50 5 55
77499 0 0 0 0 0 0
77520 0 0 0 0 0 0
77522 0 0 0 0 0 0
77523 0 0 0 0 0 0
77525 0 0 0 0 0 0
77600 0 0 0 0 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
77605 0 0 0 0 0 45
77610 0 0 0 0 0 41
77615 0 0 0 0 0 45
77620 0 0 0 0 0 46
77750 8 0 0 40 20 100
77761 11 0 0 45 10 82
77762 18 0 0 60 19 113
77763 20 0 0 80 28 160
77767 1 20 1 22
77768 4 35 3 42
77770 6 45 10 61
77771 6 70 15 91
77772 6 100 18 124
77778 20 5 90 30 145
77789 12 0 0 20 5 53
77790 0
77799 0 0 0 0 0 0
78012 5 0 0 5 5 15
78013 5 0 0 10 5 20
78014 5 0 0 10 5 20
78015 0 0 0 31 0 31
78016 0 0 0 49 0 49
78018 0 0 0 29 0 29
78020 0 0 0 20 0 20
78070 5 0 0 10 5 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
78071 5 0 0 15 5 25
78072 5 0 0 20 5 30
78075 0 0 0 38 0 38
78099 0 0 0 0 0 0
78102 0 0 0 18 0 18
78103 0 0 0 22 0 22
78104 0 0 0 20 0 20
78110 0 0 0 9 0 9
78111 0 0 0 10 0 10
78120 0 0 0 10 0 10
78121 0 0 0 12 0 12
78122 0 0 0 19 0 19
78130 0 0 0 24 0 24
78135 0 0 0 48 0 48
78140 0 0 0 40 0 40
78185 0 0 0 16 0 16
78190 0 0 0 40 0 40
78191 0 0 0 25 0 25
78195 0 0 0 30 0 30
78199 0 0 0 0 0 0
78201 0 0 0 16 0 16
78202 0 0 0 20 0 20
78205 0 0 0 20 0 20
78206 0 0 0 25 0 25
78215 0 0 0 13 0 13
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
78216 0 0 0 22 0 22
78226 5 0 0 10 5 20
78227 6 0 0 15 5 26
78230 0 0 0 19 0 19
78231 0 0 0 23 0 23
78232 0 0 0 28 0 28
78258 0 0 0 27 0 27
78261 0 0 0 21 0 21
78262 0 0 0 25 0 25
78264 5 10 5 20
78265 5 15 5 25
78266 6 20 10 36
78267 0 0 0 0 0 0
78268 3 0 0 4 5 12
78270 0 0 0 12 0 12
78271 0 0 0 10 0 10
78272 0 0 0 12 0 12
78278 5 0 0 15 10 30
78282 0 0 0 0 0 33
78290 0 0 0 18 0 18
78291 0 0 0 31 0 31
78299 0 0 0 0 0 0
78300 0 0 0 15 0 15
78305 0 0 0 22 0 22
78306 5 0 0 8 5 18
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
78315 5 0 0 8 5 18
78320 0 0 0 24 0 24
78350 0 0 0 15 0 15
78351 0 0 0 0 0 13
78399 0 0 0 0 0 0
78414 0 0 0 0 0 26
78428 0 0 0 33 0 33
78445 0 0 0 17 0 17
78451 10 0 0 15 10 35
78452 10 0 0 20 10 40
78453 5 0 0 10 5 20
78454 5 0 0 15 5 25
78456 0 0 0 30 0 30
78457 0 0 0 32 0 32
78458 0 0 0 24 0 24
78459 0 0 0 65 0 65
78466 0 0 0 17 0 17
78468 0 0 0 26 0 26
78469 0 0 0 26 0 26
78472 5 0 0 10 5 20
78473 0 0 0 33 0 33
78481 0 0 0 21 0 21
78483 0 0 0 27 0 27
78491 0 0 0 45 0 45
78492 0 0 0 55 0 55
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
78494 3 0 0 23 0 26
78496 0 0 0 19 0 19
78499 0 0 0 0 0 0
78579 5 0 0 5 5 15
78580 5 0 0 10 5 20
78582 5 0 0 12 10 27
78597 5 0 0 10 5 20
78598 5 0 0 10 9 24
78599 0 0 0 0 0 0
78600 0 0 0 16 0 16
78601 0 0 0 18 0 18
78605 0 0 0 21 0 21
78606 0 0 0 22 0 22
78607 0 0 0 29 0 29
78608 0 0 0 56 0 56
78609 0 0 0 55 0 55
78610 0 0 0 10 0 10
78630 0 0 0 24 0 24
78635 0 0 0 36 0 36
78645 0 0 0 32 0 32
78647 0 0 0 0 0 29
78650 0 0 0 40 0 40
78660 0 0 0 16 0 16
78699 0 0 0 0 0 0
78700 0 0 0 17 0 17
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
78701 0 0 0 18 0 18
78707 0 0 0 22 0 22
78708 0 0 0 32 0 32
78709 0 0 0 40 0 40
78710 0 0 0 21 0 21
78725 0 0 0 21 0 21
78730 0 0 0 5 0 5
78740 0 0 0 30 0 30
78761 0 0 0 20 0 20
78799 0 0 0 0 0 0
78800 0 0 0 28 0 28
78801 0 0 0 32 0 32
78802 12.5 0 0 17.5 10 40
78803 0 0 0 43 0 43
78804 30 0 0 20 20 70
78805 0 0 0 25 0 25
78806 0 0 0 23 0 23
78807 0 0 0 37 0 37
78808 5 0 0 5 3 13
78811 10 0 0 20 10 40
78812 10 0 0 30 10 50
78813 15 0 0 30 10 55
78814 15 0 0 30 15 60
78815 15 0 0 35 15 65
78816 15 0 0 40 15 70
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
78999 0 0 0 0 0 0
79005 20 0 0 15 10 45
79101 30 0 0 30 20 80
79200 0 0 0 75 0 75
79300 0 0 0 0 0 42
79403 30 0 0 30 15 75
79440 0 0 0 0 0 48
79445 30 0 0 45 20 95
79999 0 0 0 0 0 0
80047 0 0 0 0 0 0
80048 0 0 0 0 0 0
80050 0 0 0 0 0 0
80051 0 0 0 0 0 0
80053 0 0 0 0 0 0
80055 0 0 0 0 0 0
80061 0 0 0 0 0 0
80069 0 0 0 0 0 0
80074 0 0 0 0 0 0
80076 0 0 0 0 0 0
80150 0 0 0 0 0 0
80156 0 0 0 0 0 0
80157 0 0 0 0 0 0
80158 0 0 0 0 0 0
80162 0 0 0 0 0 0
80164 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
80168 0 0 0 0 0 0
80170 0 0 0 0 0 0
80173 0 0 0 0 0 0
80176 0 0 0 0 0 0
80178 0 0 0 0 0 0
80184 0 0 0 0 0 0
80185 0 0 0 0 0 0
80186 0 0 0 0 0 0
80188 0 0 0 0 0 0
80190 0 0 0 0 0 0
80192 0 0 0 0 0 0
80194 0 0 0 0 0 0
80195 0 0 0 0 0 0
80197 0 0 0 0 0 0
80198 0 0 0 0 0 0
80200 0 0 0 0 0 0
80201 0 0 0 0 0 0
80202 0 0 0 0 0 0
80299 0 0 0 0 0 0
80305 0 0 0 0 0 0
80306 0 0 0 0 0 0
80307 0 0 0 0 0 0
80400 0 0 0 0 0 0
80402 0 0 0 0 0 0
80406 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
80408 0 0 0 0 0 0
80410 0 0 0 0 0 0
80412 0 0 0 0 0 0
80414 0 0 0 0 0 0
80415 0 0 0 0 0 0
80416 0 0 0 0 0 0
80417 0 0 0 0 0 0
80418 0 0 0 0 0 0
80420 0 0 0 0 0 0
80422 0 0 0 0 0 0
80424 0 0 0 0 0 0
80426 0 0 0 0 0 0
80428 0 0 0 0 0 0
80430 0 0 0 0 0 0
80432 0 0 0 0 0 0
80434 0 0 0 0 0 0
80435 0 0 0 0 0 0
80436 0 0 0 0 0 0
80438 0 0 0 0 0 0
80439 0 0 0 0 0 0
80500 0 0 0 0 0 13
80502 0 0 0 0 0 42
81000 0 0 0 0 0 0
81001 0 0 0 0 0 0
81002 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
81003 0 0 0 0 0 0
81005 0 0 0 0 0 0
81007 0 0 0 0 0 0
81015 0 0 0 0 0 0
81020 0 0 0 0 0 0
81025 0 0 0 0 0 0
81050 0 0 0 0 0 0
81099 0 0 0 0 0 0
81327 0 0 0 0 0 0
81413 0 0 0 0 0 0
81414 0 0 0 0 0 0
81422 0 0 0 0 0 0
81439 0 0 0 0 0 0
81539 0 0 0 0 0 0
82009 0 0 0 0 0 0
82010 0 0 0 0 0 0
82013 0 0 0 0 0 0
82016 0 0 0 0 0 0
82017 0 0 0 0 0 0
82024 0 0 0 0 0 0
82030 0 0 0 0 0 0
82040 0 0 0 0 0 0
82042 0 0 0 0 0 0
82043 0 0 0 0 0 0
82044 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
82045 0 0 0 0 0 0
82075 0 0 0 0 0 0
82085 0 0 0 0 0 0
82088 0 0 0 0 0 0
82103 0 0 0 0 0 0
82104 0 0 0 0 0 0
82105 0 0 0 0 0 0
82106 0 0 0 0 0 0
82107 0 0 0 0 0 0
82108 0 0 0 0 0 0
82120 0 0 0 0 0 0
82127 0 0 0 0 0 0
82128 0 0 0 0 0 0
82131 0 0 0 0 0 0
82135 0 0 0 0 0 0
82136 0 0 0 0 0 0
82139 0 0 0 0 0 0
82140 0 0 0 0 0 0
82143 0 0 0 0 0 0
82150 0 0 0 0 0 0
82154 0 0 0 0 0 0
82157 0 0 0 0 0 0
82160 0 0 0 0 0 0
82163 0 0 0 0 0 0
82164 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
82172 0 0 0 0 0 0
82175 0 0 0 0 0 0
82180 0 0 0 0 0 0
82190 0 0 0 0 0 0
82232 0 0 0 0 0 0
82239 0 0 0 0 0 0
82240 0 0 0 0 0 0
82247 0 0 0 0 0 0
82248 0 0 0 0 0 0
82252 0 0 0 0 0 0
82261 0 0 0 0 0 0
82270 0 0 0 0 0 0
82271 0 0 0 0 0 0
82272 0 0 0 0 0 0
82274 0 0 0 0 0 0
82286 0 0 0 0 0 0
82300 0 0 0 0 0 0
82306 0 0 0 0 0 0
82308 0 0 0 0 0 0
82310 0 0 0 0 0 0
82330 0 0 0 0 0 0
82331 0 0 0 0 0 0
82340 0 0 0 0 0 0
82355 0 0 0 0 0 0
82360 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
82365 0 0 0 0 0 0
82370 0 0 0 0 0 0
82373 0 0 0 0 0 0
82374 0 0 0 0 0 0
82375 0 0 0 0 0 0
82376 0 0 0 0 0 0
82378 0 0 0 0 0 0
82379 0 0 0 0 0 0
82380 0 0 0 0 0 0
82382 0 0 0 0 0 0
82383 0 0 0 0 0 0
82384 0 0 0 0 0 0
82387 0 0 0 0 0 0
82390 0 0 0 0 0 0
82397 0 0 0 0 0 0
82415 0 0 0 0 0 0
82435 0 0 0 0 0 0
82436 0 0 0 0 0 0
82438 0 0 0 0 0 0
82441 0 0 0 0 0 0
82465 0 0 0 0 0 0
82480 0 0 0 0 0 0
82482 0 0 0 0 0 0
82485 0 0 0 0 0 0
82486 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
82487 0 0 0 0 0 0
82488 0 0 0 0 0 0
82489 0 0 0 0 0 0
82491 0 0 0 0 0 0
82492 0 0 0 0 0 0
82495 0 0 0 0 0 0
82507 0 0 0 0 0 0
82523 0 0 0 0 0 0
82525 0 0 0 0 0 0
82528 0 0 0 0 0 0
82530 0 0 0 0 0 0
82533 0 0 0 0 0 0
82540 0 0 0 0 0 0
82541 0 0 0 0 0 0
82542 0 0 0 0 0 0
82543 0 0 0 0 0 0
82544 0 0 0 0 0 0
82550 0 0 0 0 0 0
82552 0 0 0 0 0 0
82553 0 0 0 0 0 0
82554 0 0 0 0 0 0
82565 0 0 0 0 0 0
82570 0 0 0 0 0 0
82575 0 0 0 0 0 0
82585 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
82595 0 0 0 0 0 0
82600 0 0 0 0 0 0
82607 0 0 0 0 0 0
82608 0 0 0 0 0 0
82610 0 0 0 0 0 0
82615 0 0 0 0 0 0
82626 0 0 0 0 0 0
82627 0 0 0 0 0 0
82633 0 0 0 0 0 0
82634 0 0 0 0 0 0
82638 0 0 0 0 0 0
82652 0 0 0 0 0 0
82656 0 0 0 0 0 0
82657 0 0 0 0 0 0
82658 0 0 0 0 0 0
82664 0 0 0 0 0 0
82668 0 0 0 0 0 0
82670 0 0 0 0 0 0
82671 0 0 0 0 0 0
82672 0 0 0 0 0 0
82677 0 0 0 0 0 0
82679 0 0 0 0 0 0
82693 0 0 0 0 0 0
82696 0 0 0 0 0 0
82705 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
82710 0 0 0 0 0 0
82715 0 0 0 0 0 0
82725 0 0 0 0 0 0
82726 0 0 0 0 0 0
82728 0 0 0 0 0 0
82731 0 0 0 0 0 0
82735 0 0 0 0 0 0
82746 0 0 0 0 0 0
82747 0 0 0 0 0 0
82757 0 0 0 0 0 0
82759 0 0 0 0 0 0
82760 0 0 0 0 0 0
82775 0 0 0 0 0 0
82776 0 0 0 0 0 0
82784 0 0 0 0 0 0
82785 0 0 0 0 0 0
82787 0 0 0 0 0 0
82800 0 0 0 0 0 0
82803 0 0 0 0 0 0
82805 0 0 0 0 0 0
82810 0 0 0 0 0 0
82820 0 0 0 0 0 0
82938 0 0 0 0 0 0
82941 0 0 0 0 0 0
82943 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
82945 0 0 0 0 0 0
82946 0 0 0 0 0 0
82947 0 0 0 0 0 0
82948 0 0 0 0 0 0
82950 0 0 0 0 0 0
82951 0 0 0 0 0 0
82952 0 0 0 0 0 0
82955 0 0 0 0 0 0
82960 0 0 0 0 0 0
82962 0 0 0 0 0 0
82963 0 0 0 0 0 0
82965 0 0 0 0 0 0
82977 0 0 0 0 0 0
82978 0 0 0 0 0 0
82979 0 0 0 0 0 0
82985 0 0 0 0 0 0
83001 0 0 0 0 0 0
83002 0 0 0 0 0 0
83003 0 0 0 0 0 0
83009 0 0 0 0 0 0
83010 0 0 0 0 0 0
83012 0 0 0 0 0 0
83013 0 0 0 0 0 0
83014 0 0 0 0 0 0
83015 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
83018 0 0 0 0 0 0
83020 3 0 0 7 5 15
83021 0 0 0 0 0 0
83026 0 0 0 0 0 0
83030 0 0 0 0 0 0
83033 0 0 0 0 0 0
83036 0 0 0 0 0 0
83037 0 0 0 0 0 0
83045 0 0 0 0 0 0
83050 0 0 0 0 0 0
83051 0 0 0 0 0 0
83060 0 0 0 0 0 0
83065 0 0 0 0 0 0
83068 0 0 0 0 0 0
83069 0 0 0 0 0 0
83070 0 0 0 0 0 0
83080 0 0 0 0 0 0
83088 0 0 0 0 0 0
83090 0 0 0 0 0 0
83150 0 0 0 0 0 0
83491 0 0 0 0 0 0
83497 0 0 0 0 0 0
83498 0 0 0 0 0 0
83499 0 0 0 0 0 0
83500 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
83505 0 0 0 0 0 0
83516 0 0 0 0 0 0
83518 0 0 0 0 0 0
83519 0 0 0 0 0 0
83520 0 0 0 0 0 0
83525 0 0 0 0 0 0
83527 0 0 0 0 0 0
83528 0 0 0 0 0 0
83540 0 0 0 0 0 0
83550 0 0 0 0 0 0
83570 0 0 0 0 0 0
83582 0 0 0 0 0 0
83586 0 0 0 0 0 0
83593 0 0 0 0 0 0
83605 0 0 0 0 0 0
83615 0 0 0 0 0 0
83625 0 0 0 0 0 0
83630 0 0 0 0 0 0
83631 0 0 0 0 0 0
83632 0 0 0 0 0 0
83633 0 0 0 0 0 0
83655 0 0 0 0 0 0
83661 0 0 0 0 0 0
83662 0 0 0 0 0 0
83663 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
83664 0 0 0 0 0 0
83670 0 0 0 0 0 0
83690 0 0 0 0 0 0
83695 0 0 0 0 0 0
83698 0 0 0 0 0 0
83700 0 0 0 0 0 0
83701 0 0 0 0 0 0
83704 0 0 0 0 0 0
83718 0 0 0 0 0 0
83719 0 0 0 0 0 0
83721 0 0 0 0 0 0
83727 0 0 0 0 0 0
83735 0 0 0 0 0 0
83775 0 0 0 0 0 0
83785 0 0 0 0 0 0
83788 0 0 0 0 0 0
83789 0 0 0 0 0 0
83825 0 0 0 0 0 0
83835 0 0 0 0 0 0
83857 0 0 0 0 0 0
83864 0 0 0 0 0 0
83872 0 0 0 0 0 0
83873 0 0 0 0 0 0
83874 0 0 0 0 0 0
83876 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
83880 0 0 0 0 0 0
83883 0 0 0 0 0 0
83885 0 0 0 0 0 0
83915 0 0 0 0 0 0
83916 0 0 0 0 0 0
83918 0 0 0 0 0 0
83919 0 0 0 0 0 0
83921 0 0 0 0 0 0
83930 0 0 0 0 0 0
83935 0 0 0 0 0 0
83937 0 0 0 0 0 0
83945 0 0 0 0 0 0
83950 0 0 0 0 0 0
83951 0 0 0 0 0 0
83970 0 0 0 0 0 0
83986 0 0 0 0 0 0
83987 0 0 0 0 0 0
83992 0 0 0 0 0 0
83993 0 0 0 0 0 0
84030 0 0 0 0 0 0
84035 0 0 0 0 0 0
84060 0 0 0 0 0 0
84061 0 0 0 0 0 0
84066 0 0 0 0 0 0
84075 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
84078 0 0 0 0 0 0
84080 0 0 0 0 0 0
84081 0 0 0 0 0 0
84085 0 0 0 0 0 0
84087 0 0 0 0 0 0
84100 0 0 0 0 0 0
84105 0 0 0 0 0 0
84106 0 0 0 0 0 0
84110 0 0 0 0 0 0
84119 0 0 0 0 0 0
84120 0 0 0 0 0 0
84126 0 0 0 0 0 0
84132 0 0 0 0 0 0
84133 0 0 0 0 0 0
84134 0 0 0 0 0 0
84135 0 0 0 0 0 0
84138 0 0 0 0 0 0
84140 0 0 0 0 0 0
84143 0 0 0 0 0 0
84144 0 0 0 0 0 0
84145 0 0 0 0 0 0
84146 0 0 0 0 0 0
84150 0 0 0 0 0 0
84152 0 0 0 0 0 0
84153 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
84154 0 0 0 0 0 0
84155 0 0 0 0 0 0
84156 0 0 0 0 0 0
84157 0 0 0 0 0 0
84160 0 0 0 0 0 0
84163 0 0 0 0 0 0
84165 3 0 0 5 5 13
84166 3 0 0 5 5 13
84181 8 0 0 7 5 20
84182 5 0 0 10 5 20
84202 0 0 0 0 0 0
84203 0 0 0 0 0 0
84206 0 0 0 0 0 0
84207 0 0 0 0 0 0
84210 0 0 0 0 0 0
84220 0 0 0 0 0 0
84228 0 0 0 0 0 0
84233 0 0 0 0 0 0
84234 0 0 0 0 0 0
84235 0 0 0 0 0 0
84238 0 0 0 0 0 0
84244 0 0 0 0 0 0
84252 0 0 0 0 0 0
84255 0 0 0 0 0 0
84260 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
84270 0 0 0 0 0 0
84275 0 0 0 0 0 0
84285 0 0 0 0 0 0
84295 0 0 0 0 0 0
84300 0 0 0 0 0 0
84302 0 0 0 0 0 0
84305 0 0 0 0 0 0
84307 0 0 0 0 0 0
84311 0 0 0 0 0 0
84315 0 0 0 0 0 0
84375 0 0 0 0 0 0
84376 0 0 0 0 0 0
84377 0 0 0 0 0 0
84378 0 0 0 0 0 0
84379 0 0 0 0 0 0
84392 0 0 0 0 0 0
84402 0 0 0 0 0 0
84403 0 0 0 0 0 0
84410 0 0 0 0 0 0
84425 0 0 0 0 0 0
84430 0 0 0 0 0 0
84431 0 0 0 0 0 0
84432 0 0 0 0 0 0
84436 0 0 0 0 0 0
84437 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
84439 0 0 0 0 0 0
84442 0 0 0 0 0 0
84443 0 0 0 0 0 0
84445 0 0 0 0 0 0
84446 0 0 0 0 0 0
84449 0 0 0 0 0 0
84450 0 0 0 0 0 0
84460 0 0 0 0 0 0
84466 0 0 0 0 0 0
84478 0 0 0 0 0 0
84479 0 0 0 0 0 0
84480 0 0 0 0 0 0
84481 0 0 0 0 0 0
84482 0 0 0 0 0 0
84484 0 0 0 0 0 0
84485 0 0 0 0 0 0
84488 0 0 0 0 0 0
84490 0 0 0 0 0 0
84510 0 0 0 0 0 0
84512 0 0 0 0 0 0
84520 0 0 0 0 0 0
84525 0 0 0 0 0 0
84540 0 0 0 0 0 0
84545 0 0 0 0 0 0
84550 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
84560 0 0 0 0 0 0
84577 0 0 0 0 0 0
84578 0 0 0 0 0 0
84580 0 0 0 0 0 0
84583 0 0 0 0 0 0
84585 0 0 0 0 0 0
84586 0 0 0 0 0 0
84588 0 0 0 0 0 0
84590 0 0 0 0 0 0
84591 0 0 0 0 0 0
84597 0 0 0 0 0 0
84600 0 0 0 0 0 0
84620 0 0 0 0 0 0
84630 0 0 0 0 0 0
84681 0 0 0 0 0 0
84702 0 0 0 0 0 0
84703 0 0 0 0 0 0
84704 0 0 0 0 0 0
84830 0 0 0 0 0 0
84999 0 0 0 0 0 0
85002 0 0 0 0 0 0
85004 0 0 0 0 0 0
85007 0 0 0 0 0 0
85008 0 0 0 0 0 0
85009 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
85013 0 0 0 0 0 0
85014 0 0 0 0 0 0
85018 0 0 0 0 0 0
85025 0 0 0 0 0 0
85027 0 0 0 0 0 0
85032 0 0 0 0 0 0
85041 0 0 0 0 0 0
85044 0 0 0 0 0 0
85045 0 0 0 0 0 0
85046 0 0 0 0 0 0
85048 0 0 0 0 0 0
85049 0 0 0 0 0 0
85055 0 0 0 0 0 0
85060 0 0 0 0 0 15
85097 0 0 0 0 0 30
85130 0 0 0 0 0 0
85170 0 0 0 0 0 0
85175 0 0 0 0 0 0
85210 0 0 0 0 0 0
85220 0 0 0 0 0 0
85230 0 0 0 0 0 0
85240 0 0 0 0 0 0
85244 0 0 0 0 0 0
85245 0 0 0 0 0 0
85246 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
85247 0 0 0 0 0 0
85250 0 0 0 0 0 0
85260 0 0 0 0 0 0
85270 0 0 0 0 0 0
85280 0 0 0 0 0 0
85290 0 0 0 0 0 0
85291 0 0 0 0 0 0
85292 0 0 0 0 0 0
85293 0 0 0 0 0 0
85300 0 0 0 0 0 0
85301 0 0 0 0 0 0
85302 0 0 0 0 0 0
85303 0 0 0 0 0 0
85305 0 0 0 0 0 0
85306 0 0 0 0 0 0
85307 0 0 0 0 0 0
85335 0 0 0 0 0 0
85337 0 0 0 0 0 0
85345 0 0 0 0 0 0
85347 0 0 0 0 0 0
85348 0 0 0 0 0 0
85360 0 0 0 0 0 0
85362 0 0 0 0 0 0
85366 0 0 0 0 0 0
85370 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
85378 0 0 0 0 0 0
85379 0 0 0 0 0 0
85380 0 0 0 0 0 0
85384 0 0 0 0 0 0
85385 0 0 0 0 0 0
85390 8 0 0 17 10 35
85396 10 0 0 12.5 12.5 35
85397 0 0 0 0 0 0
85400 0 0 0 0 0 0
85410 0 0 0 0 0 0
85415 0 0 0 0 0 0
85420 0 0 0 0 0 0
85421 0 0 0 0 0 0
85441 0 0 0 0 0 0
85445 0 0 0 0 0 0
85460 0 0 0 0 0 0
85461 0 0 0 0 0 0
85475 0 0 0 0 0 0
85520 0 0 0 0 0 0
85525 0 0 0 0 0 0
85530 0 0 0 0 0 0
85536 0 0 0 0 0 0
85540 0 0 0 0 0 0
85547 0 0 0 0 0 0
85549 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
85555 0 0 0 0 0 0
85557 0 0 0 0 0 0
85576 5 0 0 8 6 19
85597 0 0 0 0 0 0
85610 0 0 0 0 0 0
85611 0 0 0 0 0 0
85612 0 0 0 0 0 0
85613 0 0 0 0 0 0
85635 0 0 0 0 0 0
85651 0 0 0 0 0 0
85652 0 0 0 0 0 0
85660 0 0 0 0 0 0
85670 0 0 0 0 0 0
85675 0 0 0 0 0 0
85705 0 0 0 0 0 0
85730 0 0 0 0 0 0
85732 0 0 0 0 0 0
85810 0 0 0 0 0 0
85999 0 0 0 0 0 0
86000 0 0 0 0 0 0
86001 0 0 0 0 0 0
86003 0 0 0 0 0 0
86005 0 0 0 0 0 0
86021 0 0 0 0 0 0
86022 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
86023 0 0 0 0 0 0
86038 0 0 0 0 0 0
86039 0 0 0 0 0 0
86060 0 0 0 0 0 0
86063 0 0 0 0 0 0
86077 0 0 0 40 0 40
86078 0 0 0 0 0 30
86079 0 0 0 30 0 30
86140 0 0 0 0 0 0
86141 0 0 0 0 0 0
86146 0 0 0 0 0 0
86147 0 0 0 0 0 0
86148 0 0 0 0 0 0
86155 0 0 0 0 0 0
86156 0 0 0 0 0 0
86157 0 0 0 0 0 0
86160 0 0 0 0 0 0
86161 0 0 0 0 0 0
86162 0 0 0 0 0 0
86171 0 0 0 0 0 0
86185 0 0 0 0 0 0
86200 0 0 0 0 0 0
86215 0 0 0 0 0 0
86225 0 0 0 0 0 0
86226 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
86235 0 0 0 0 0 0
86243 0 0 0 0 0 0
86255 3 0 0 5 5 13
86256 3 0 0 5 5 13
86277 0 0 0 0 0 0
86280 0 0 0 0 0 0
86294 0 0 0 0 0 0
86300 0 0 0 0 0 0
86301 0 0 0 0 0 0
86304 0 0 0 0 0 0
86305 0 0 0 0 0 0
86308 0 0 0 0 0 0
86309 0 0 0 0 0 0
86310 0 0 0 0 0 0
86316 0 0 0 0 0 0
86317 0 0 0 0 0 0
86318 0 0 0 0 0 0
86320 5 0 0 9 3 17
86325 3 0 0 8 3 14
86327 5 0 0 14 8 27
86329 0 0 0 0 0 0
86331 0 0 0 0 0 0
86332 0 0 0 0 0 0
86334 4 0 0 6 5 15
86335 4 0 0 6 5 15
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
86336 0 0 0 0 0 0
86337 0 0 0 0 0 0
86340 0 0 0 0 0 0
86341 0 0 0 0 0 0
86343 0 0 0 0 0 0
86344 0 0 0 0 0 0
86352 0 0 0 0 0 0
86353 0 0 0 0 0 0
86355 0 0 0 0 0 0
86356 0 0 0 0 0 0
86357 0 0 0 0 0 0
86359 0 0 0 0 0 0
86360 0 0 0 0 0 0
86361 0 0 0 0 0 0
86367 0 0 0 0 0 0
86376 0 0 0 0 0 0
86378 0 0 0 0 0 0
86382 0 0 0 0 0 0
86384 0 0 0 0 0 0
86403 0 0 0 0 0 0
86406 0 0 0 0 0 0
86430 0 0 0 0 0 0
86431 0 0 0 0 0 0
86480 0 0 0 0 0 0
86485 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
86486 0 0 0 0 0 0
86490 0 0 0 0 0 0
86510 0 0 0 0 0 0
86580 0 0 0 0 0 0
86590 0 0 0 0 0 0
86592 0 0 0 0 0 0
86593 0 0 0 0 0 0
86602 0 0 0 0 0 0
86603 0 0 0 0 0 0
86606 0 0 0 0 0 0
86609 0 0 0 0 0 0
86611 0 0 0 0 0 0
86612 0 0 0 0 0 0
86615 0 0 0 0 0 0
86617 0 0 0 0 0 0
86618 0 0 0 0 0 0
86619 0 0 0 0 0 0
86622 0 0 0 0 0 0
86625 0 0 0 0 0 0
86628 0 0 0 0 0 0
86631 0 0 0 0 0 0
86632 0 0 0 0 0 0
86635 0 0 0 0 0 0
86638 0 0 0 0 0 0
86641 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
86644 0 0 0 0 0 0
86645 0 0 0 0 0 0
86648 0 0 0 0 0 0
86651 0 0 0 0 0 0
86652 0 0 0 0 0 0
86653 0 0 0 0 0 0
86654 0 0 0 0 0 0
86658 0 0 0 0 0 0
86663 0 0 0 0 0 0
86664 0 0 0 0 0 0
86665 0 0 0 0 0 0
86666 0 0 0 0 0 0
86668 0 0 0 0 0 0
86671 0 0 0 0 0 0
86674 0 0 0 0 0 0
86677 0 0 0 0 0 0
86682 0 0 0 0 0 0
86684 0 0 0 0 0 0
86687 0 0 0 0 0 0
86688 0 0 0 0 0 0
86689 0 0 0 0 0 0
86692 0 0 0 0 0 0
86694 0 0 0 0 0 0
86695 0 0 0 0 0 0
86696 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
86698 0 0 0 0 0 0
86701 0 0 0 0 0 0
86702 0 0 0 0 0 0
86703 0 0 0 0 0 0
86704 0 0 0 0 0 0
86705 0 0 0 0 0 0
86706 0 0 0 0 0 0
86707 0 0 0 0 0 0
86708 0 0 0 0 0 0
86709 0 0 0 0 0 0
86710 0 0 0 0 0 0
86713 0 0 0 0 0 0
86717 0 0 0 0 0 0
86720 0 0 0 0 0 0
86723 0 0 0 0 0 0
86727 0 0 0 0 0 0
86729 0 0 0 0 0 0
86732 0 0 0 0 0 0
86735 0 0 0 0 0 0
86738 0 0 0 0 0 0
86741 0 0 0 0 0 0
86744 0 0 0 0 0 0
86747 0 0 0 0 0 0
86750 0 0 0 0 0 0
86753 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
86756 0 0 0 0 0 0
86757 0 0 0 0 0 0
86759 0 0 0 0 0 0
86762 0 0 0 0 0 0
86765 0 0 0 0 0 0
86768 0 0 0 0 0 0
86771 0 0 0 0 0 0
86774 0 0 0 0 0 0
86777 0 0 0 0 0 0
86778 0 0 0 0 0 0
86780 0 0 0 0 0 0
86784 0 0 0 0 0 0
86787 0 0 0 0 0 0
86788 0 0 0 0 0 0
86789 0 0 0 0 0 0
86790 0 0 0 0 0 0
86793 0 0 0 0 0 0
86800 0 0 0 0 0 0
86803 0 0 0 0 0 0
86804 0 0 0 0 0 0
86805 0 0 0 0 0 0
86806 0 0 0 0 0 0
86807 0 0 0 0 0 0
86808 0 0 0 0 0 0
86812 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
86813 0 0 0 0 0 0
86816 0 0 0 0 0 0
86817 0 0 0 0 0 0
86821 0 0 0 0 0 0
86822 0 0 0 0 0 0
86825 0 0 0 0 0 0
86826 0 0 0 0 0 0
86849 0 0 0 0 0 0
86850 0 0 0 0 0 0
86860 0 0 0 0 0 0
86870 0 0 0 0 0 0
86880 0 0 0 0 0 0
86885 0 0 0 0 0 0
86886 0 0 0 0 0 0
86890 0 0 0 0 0 0
86891 0 0 0 0 0 0
86900 0 0 0 0 0 0
86901 0 0 0 0 0 0
86904 0 0 0 0 0 0
86905 0 0 0 0 0 0
86906 0 0 0 0 0 0
86910 0 0 0 0 0 0
86911 0 0 0 0 0 0
86920 0 0 0 0 0 0
86921 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
86922 0 0 0 0 0 0
86923 0 0 0 0 0 0
86927 0 0 0 0 0 0
86930 0 0 0 0 0 0
86931 0 0 0 0 0 0
86932 0 0 0 0 0 0
86940 0 0 0 0 0 0
86941 0 0 0 0 0 0
86945 0 0 0 0 0 0
86950 0 0 0 0 0 0
86960 0 0 0 0 0 0
86965 0 0 0 0 0 0
86970 0 0 0 0 0 0
86971 0 0 0 0 0 0
86972 0 0 0 0 0 0
86975 0 0 0 0 0 0
86976 0 0 0 0 0 0
86977 0 0 0 0 0 0
86978 0 0 0 0 0 0
86985 0 0 0 0 0 0
86999 0 0 0 0 0 0
87003 0 0 0 0 0 0
87015 0 0 0 0 0 0
87040 0 0 0 0 0 0
87045 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
87046 0 0 0 0 0 0
87070 0 0 0 0 0 0
87071 0 0 0 0 0 0
87073 0 0 0 0 0 0
87075 0 0 0 0 0 0
87076 0 0 0 0 0 0
87077 0 0 0 0 0 0
87081 0 0 0 0 0 0
87084 0 0 0 0 0 0
87086 0 0 0 0 0 0
87088 0 0 0 0 0 0
87101 0 0 0 0 0 0
87102 0 0 0 0 0 0
87103 0 0 0 0 0 0
87106 0 0 0 0 0 0
87107 0 0 0 0 0 0
87109 0 0 0 0 0 0
87110 0 0 0 0 0 0
87116 0 0 0 0 0 0
87118 0 0 0 0 0 0
87140 0 0 0 0 0 0
87143 0 0 0 0 0 0
87147 0 0 0 0 0 0
87149 0 0 0 0 0 0
87150 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
87152 0 0 0 0 0 0
87153 0 0 0 0 0 0
87158 0 0 0 0 0 0
87164 0 0 0 0 0 13
87166 0 0 0 0 0 0
87168 0 0 0 0 0 0
87169 0 0 0 0 0 0
87172 0 0 0 0 0 0
87176 0 0 0 0 0 0
87177 0 0 0 0 0 0
87181 0 0 0 0 0 0
87184 0 0 0 0 0 0
87185 0 0 0 0 0 0
87186 0 0 0 0 0 0
87187 0 0 0 0 0 0
87188 0 0 0 0 0 0
87190 0 0 0 0 0 0
87197 0 0 0 0 0 0
87205 0 0 0 0 0 0
87206 0 0 0 0 0 0
87207 0 0 0 0 0 10
87209 0 0 0 0 0 0
87210 0 0 0 0 0 0
87220 0 0 0 0 0 0
87230 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
87250 0 0 0 0 0 0
87252 0 0 0 0 0 0
87253 0 0 0 0 0 0
87254 0 0 0 0 0 0
87255 0 0 0 0 0 0
87260 0 0 0 0 0 0
87265 0 0 0 0 0 0
87267 0 0 0 0 0 0
87269 0 0 0 0 0 0
87270 0 0 0 0 0 0
87271 0 0 0 0 0 0
87272 0 0 0 0 0 0
87273 0 0 0 0 0 0
87274 0 0 0 0 0 0
87275 0 0 0 0 0 0
87276 0 0 0 0 0 0
87277 0 0 0 0 0 0
87278 0 0 0 0 0 0
87279 0 0 0 0 0 0
87280 0 0 0 0 0 0
87281 0 0 0 0 0 0
87283 0 0 0 0 0 0
87285 0 0 0 0 0 0
87290 0 0 0 0 0 0
87299 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
87300 0 0 0 0 0 0
87301 0 0 0 0 0 0
87305 0 0 0 0 0 0
87320 0 0 0 0 0 0
87324 0 0 0 0 0 0
87327 0 0 0 0 0 0
87328 0 0 0 0 0 0
87329 0 0 0 0 0 0
87332 0 0 0 0 0 0
87335 0 0 0 0 0 0
87336 0 0 0 0 0 0
87337 0 0 0 0 0 0
87338 0 0 0 0 0 0
87339 0 0 0 0 0 0
87340 0 0 0 0 0 0
87341 0 0 0 0 0 0
87350 0 0 0 0 0 0
87380 0 0 0 0 0 0
87385 0 0 0 0 0 0
87390 0 0 0 0 0 0
87391 0 0 0 0 0 0
87400 0 0 0 0 0 0
87420 0 0 0 0 0 0
87425 0 0 0 0 0 0
87427 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
87430 0 0 0 0 0 0
87449 0 0 0 0 0 0
87450 0 0 0 0 0 0
87451 0 0 0 0 0 0
87470 0 0 0 0 0 0
87471 0 0 0 0 0 0
87472 0 0 0 0 0 0
87475 0 0 0 0 0 0
87476 0 0 0 0 0 0
87477 0 0 0 0 0 0
87480 0 0 0 0 0 0
87481 0 0 0 0 0 0
87482 0 0 0 0 0 0
87483 0 0 0 0 0 0
87485 0 0 0 0 0 0
87486 0 0 0 0 0 0
87487 0 0 0 0 0 0
87490 0 0 0 0 0 0
87491 0 0 0 0 0 0
87492 0 0 0 0 0 0
87493 0 0 0 0 0 0
87495 0 0 0 0 0 0
87496 0 0 0 0 0 0
87497 0 0 0 0 0 0
87498 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
87500 0 0 0 0 0 0
87510 0 0 0 0 0 0
87511 0 0 0 0 0 0
87512 0 0 0 0 0 0
87515 0 0 0 0 0 0
87516 0 0 0 0 0 0
87517 0 0 0 0 0 0
87520 0 0 0 0 0 0
87521 0 0 0 0 0 0
87522 0 0 0 0 0 0
87525 0 0 0 0 0 0
87526 0 0 0 0 0 0
87527 0 0 0 0 0 0
87528 0 0 0 0 0 0
87529 0 0 0 0 0 0
87530 0 0 0 0 0 0
87531 0 0 0 0 0 0
87532 0 0 0 0 0 0
87533 0 0 0 0 0 0
87534 0 0 0 0 0 0
87535 0 0 0 0 0 0
87536 0 0 0 0 0 0
87537 0 0 0 0 0 0
87538 0 0 0 0 0 0
87539 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
87540 0 0 0 0 0 0
87541 0 0 0 0 0 0
87542 0 0 0 0 0 0
87550 0 0 0 0 0 0
87551 0 0 0 0 0 0
87552 0 0 0 0 0 0
87555 0 0 0 0 0 0
87556 0 0 0 0 0 0
87557 0 0 0 0 0 0
87560 0 0 0 0 0 0
87561 0 0 0 0 0 0
87562 0 0 0 0 0 0
87580 0 0 0 0 0 0
87581 0 0 0 0 0 0
87582 0 0 0 0 0 0
87590 0 0 0 0 0 0
87591 0 0 0 0 0 0
87592 0 0 0 0 0 0
87640 0 0 0 0 0 0
87641 0 0 0 0 0 0
87650 0 0 0 0 0 0
87651 0 0 0 0 0 0
87652 0 0 0 0 0 0
87653 0 0 0 0 0 0
87660 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
87797 0 0 0 0 0 0
87798 0 0 0 0 0 0
87799 0 0 0 0 0 0
87800 0 0 0 0 0 0
87801 0 0 0 0 0 0
87802 0 0 0 0 0 0
87803 0 0 0 0 0 0
87804 0 0 0 0 0 0
87807 0 0 0 0 0 0
87808 0 0 0 0 0 0
87809 0 0 0 0 0 0
87810 0 0 0 0 0 0
87850 0 0 0 0 0 0
87880 0 0 0 0 0 0
87899 0 0 0 0 0 0
87900 0 0 0 0 0 0
87901 0 0 0 0 0 0
87902 0 0 0 0 0 0
87903 0 0 0 0 0 0
87904 0 0 0 0 0 0
87905 0 0 0 0 0 0
87999 0 0 0 0 0 0
88000 0 0 0 0 0 0
88005 0 0 0 0 0 0
88007 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
88012 0 0 0 0 0 0
88014 0 0 0 0 0 0
88016 0 0 0 0 0 0
88020 0 0 0 0 0 0
88025 0 0 0 0 0 0
88027 0 0 0 0 0 0
88028 0 0 0 0 0 0
88029 0 0 0 0 0 0
88036 0 0 0 0 0 0
88037 0 0 0 0 0 0
88040 0 0 0 0 0 0
88045 0 0 0 0 0 0
88099 0 0 0 0 0 0
88104 24 24
88106 16 16
88108 19 19
88112 15 15
88120 0 0 0 30 0 30
88121 0 0 0 25 0 25
88125 0 0 0 0 0 9
88130 0 0 0 0 0 0
88140 0 0 0 0 0 0
88141 0 0 0 0 0 16
88142 0 0 0 0 0 0
88143 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
88147 0 0 0 0 0 0
88148 0 0 0 0 0 0
88150 0 0 0 0 0 0
88152 0 0 0 0 0 0
88153 0 0 0 0 0 0
88154 0 0 0 0 0 0
88155 0 0 0 0 0 0
88160 22 22
88161 17
88162 24
88164 0 0 0 0 0 0
88165 0 0 0 0 0 0
88166 0 0 0 0 0 0
88167 0 0 0 0 0 0
88172 0 0 0 20 0 20
88173 15 0 0 25 10 50
88174 0 0 0 0 0 0
88175 0 0 0 0 0 0
88177 0 0 0 15 0 15
88182 4 0 0 10 6 20
88184 0
88185 0
88187 20 20
88188 30 30
88189 36 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
88199 0 0 0 0 0 0
88230 0 0 0 0 0 0
88233 0 0 0 0 0 0
88235 0 0 0 0 0 0
88237 0 0 0 0 0 0
88239 0 0 0 0 0 0
88240 0 0 0 0 0 0
88241 0 0 0 0 0 0
88245 0 0 0 0 0 0
88248 0 0 0 0 0 0
88249 0 0 0 0 0 0
88261 0 0 0 0 0 0
88262 0 0 0 0 0 0
88263 0 0 0 0 0 0
88264 0 0 0 0 0 0
88267 0 0 0 0 0 0
88269 0 0 0 0 0 0
88271 0 0 0 0 0 0
88272 0 0 0 0 0 0
88273 0 0 0 0 0 0
88274 0 0 0 0 0 0
88275 0 0 0 0 0 0
88280 0 0 0 0 0 0
88283 0 0 0 0 0 0
88285 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
88289 0 0 0 0 0 0
88291 0 0 0 20 0 20
88299 0 0 0 0 0 0
88300 0 0 0 10 0 10
88302 0 0 0 11 0 11
88304 0 0 0 15 0 15
88305 0 0 0 25 0 25
88307 0 0 0 47 0 47
88309 0 0 0 90 0 90
88311 0 0 0 5 2 7
88312 0 0 0 24 0 24
88313 0 0 0 13 0 13
88314 0 0 0 13 0 13
88319 0 0 0 18 0 18
88321 50 50
88323 60 60
88325 90 90
88329 0 0 0 21 0 21
88331 0 0 0 25 0 25
88332 0 0 0 16 0 16
88333 0 0 0 25 0 25
88334 0 0 0 20 0 20
88341 25 25
88342 0 0 0 25 0 25
88344 0 0 0 35 0 35
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
88346 0 0 0 24 0 24
88348 0 0 0 0 0 47
88350 23 23
88355 0 0 0 0 0 57
88356 0 0 0 90 0 90
88358 8 0 0 20 10 38
88360 0 0 0 35 0 35
88361 0 0 0 40 0 40
88362 0 0 0 0 0 67
88363 0 0 0 17 0 17
88364 30 30
88365 0 0 0 30 0 30
88366 0 0 0 40 0 40
88367 0 0 0 25 0 25
88368 0 0 0 30 0 30
88369 30 30
88371 0 0 0 0 0 13
88372 0 0 0 0 0 13
88373 25 25
88374 0 0 0 30 0 30
88375 5 0 0 25 0 30
88377 0 0 0 45 0 45
88380 0 0 0 33 0 33
88381 0 0 0 20 0 20
88387 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
88388 0 0 0 12 0 12
88399 0 0 0 0 0 0
88720 0 0 0 0 0 0
88738 0 0 0 0 0 0
88740 0 0 0 0 0 0
88741 0 0 0 0 0 0
89049 5 0 0 0 40 45
89050 0 0 0 0 0 0
89051 0 0 0 0 0 0
89055 0 0 0 0 0 0
89060 3 0 0 10 3 16
89125 0 0 0 0 0 0
89160 0 0 0 0 0 0
89190 0 0 0 0 0 0
89220 0 0 0 0 0 0
89230 0 0 0 0 0 0
89240 0 0 0 0 0 0
89250 0 0 0 0 0 0
89251 0 0 0 0 0 0
89253 0 0 0 0 0 0
89254 0 0 0 0 0 0
89255 0 0 0 0 0 0
89257 0 0 0 0 0 0
89258 0 0 0 0 0 0
89259 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
89260 0 0 0 0 0 0
89261 0 0 0 0 0 0
89264 0 0 0 0 0 0
89268 0 0 0 0 0 0
89272 0 0 0 0 0 0
89280 0 0 0 0 0 0
89281 0 0 0 0 0 0
89290 0 0 0 0 0 0
89291 0 0 0 0 0 0
89300 0 0 0 0 0 0
89310 0 0 0 0 0 0
89320 0 0 0 0 0 0
89321 0 0 0 0 0 0
89322 0 0 0 0 0 0
89325 0 0 0 0 0 0
89329 0 0 0 0 0 0
89330 0 0 0 0 0 0
89331 0 0 0 0 0 0
89335 0 0 0 0 0 0
89342 0 0 0 0 0 0
89343 0 0 0 0 0 0
89344 0 0 0 0 0 0
89346 0 0 0 0 0 0
89352 0 0 0 0 0 0
89353 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
89354 0 0 0 0 0 0
89356 0 0 0 0 0 0
89398 0 0 0 0 0 0
90281 0 0 0 0 0 0
90283 0 0 0 0 0 0
90284 0 0 0 0 0 0
90287 0 0 0 0 0 0
90288 0 0 0 0 0 0
90291 0 0 0 0 0 0
90296 0 0 0 0 0 0
90371 0 0 0 0 0 0
90375 0 0 0 0 0 0
90376 0 0 0 0 0 0
90378 0 0 0 0 0 0
90384 0 0 0 0 0 0
90385 0 0 0 0 0 0
90386 0 0 0 0 0 0
90389 0 0 0 0 0 0
90393 0 0 0 0 0 0
90396 0 0 0 0 0 0
90399 0 0 0 0 0 0
90460 0 0 0 7 0 7
90461 0 0 0 5 0 5
90471 0 0 0 7 0 7
90472 0 0 0 7 0 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
90473 0 0 0 7 0 7
90474 0 0 0 7 0 7
90476 0 0 0 0 0 0
90477 0 0 0 0 0 0
90581 0 0 0 0 0 0
90585 0 0 0 0 0 0
90586 0 0 0 0 0 0
90632 0 0 0 0 0 0
90633 0 0 0 0 0 0
90634 0 0 0 0 0 0
90636 0 0 0 0 0 0
90645 0 0 0 0 0 0
90646 0 0 0 0 0 0
90647 0 0 0 0 0 0
90648 0 0 0 0 0 0
90649 0 0 0 0 0 0
90650 0 0 0 0 0 0
90655 0 0 0 0 0 0
90656 0 0 0 0 0 0
90657 0 0 0 0 0 0
90658 0 0 0 0 0 0
90660 0 0 0 0 0 0
90661 0 0 0 0 0 0
90662 0 0 0 0 0 0
90669 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
90670 0 0 0 0 0 0
90674 0 0 0 0 0 0
90675 0 0 0 0 0 0
90676 0 0 0 0 0 0
90680 0 0 0 0 0 0
90681 0 0 0 0 0 0
90682 0 0 0 0 0 0
90690 0 0 0 0 0 0
90691 0 0 0 0 0 0
90692 0 0 0 0 0 0
90693 0 0 0 0 0 0
90696 0 0 0 0 0 0
90698 0 0 0 0 0 0
90700 0 0 0 0 0 0
90702 0 0 0 0 0 0
90703 0 0 0 0 0 0
90704 0 0 0 0 0 0
90705 0 0 0 0 0 0
90706 0 0 0 0 0 0
90707 0 0 0 0 0 0
90708 0 0 0 0 0 0
90710 0 0 0 0 0 0
90712 0 0 0 0 0 0
90713 0 0 0 0 0 0
90714 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
90715 0 0 0 0 0 0
90716 0 0 0 0 0 0
90717 0 0 0 0 0 0
90719 0 0 0 0 0 0
90720 0 0 0 0 0 0
90721 0 0 0 0 0 0
90723 0 0 0 0 0 0
90725 0 0 0 0 0 0
90727 0 0 0 0 0 0
90732 0 0 0 0 0 0
90733 0 0 0 0 0 0
90734 0 0 0 0 0 0
90735 0 0 0 0 0 0
90736 0 0 0 0 0 0
90738 0 0 0 0 0 0
90740 0 0 0 0 0 0
90743 0 0 0 0 0 0
90744 0 0 0 0 0 0
90746 0 0 0 0 0 0
90747 0 0 0 0 0 0
90748 0 0 0 0 0 0
90749 0 0 0 0 0 0
90750 0 0 0 0 0 0
90785 0 0 0 0 11 11
90791 10 0 0 60 20 90
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
90792 10 0 0 60 20 90
90832 5 0 0 30 10 45
90833 0 0 0 30 3 33
90834 5 0 0 45 10 60
90836 0 0 0 45 3 48
90837 5 0 0 60 10 75
90838 0 0 0 60 3 63
90839 10 0 0 60 20 90
90840 0 0 0 30 0 30
90845 5 0 0 45 11 61
90846 0 0 0 50 0 50
90847 5 0 0 50 21 76
90849 11 0 0 84 14 109
90853 2 0 0 14 8 24
90863 0 0 0 15 0 15
90865 0 0 0 90 0 90
90867 7 15 0 60 10 92
90868 2 0 0 10 4 16
90869 7 10 0 45 10 72
90870 10 1 0 20 5 36
90875 10 0 0 25 10 45
90876 10 0 0 50 10 70
90880 8 0 0 50 40 98
90882 0 0 0 0 0 0
90885 0 0 0 0 0 60
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
90887 10 0 0 50 28 88
90889 0 0 0 0 0 0
90899 0 0 0 0 0 0
90901 5 0 0 45 10 60
90911 30 0 0 60 30 120
90935 10 0 0 25 10 45
90937 10 0 0 40 10 60
90940 20 0 0 2 5 27
90945 10 0 0 27 10 47
90947 10 0 0 50 10 70
90951 0 0 0 274 0 274
90952 0 0 0 0 0 0
90953 0 0 0 0 0 0
90954 0 0 0 240 0 240
90955 0 0 0 198 0 198
90956 0 0 0 148 0 148
90957 0 0 0 253 0 253
90958 0 0 0 183 0 183
90959 0 0 0 133 0 133
90960 0 0 0 128 0 128
90961 0 0 0 113 0 113
90962 0 0 0 63 0 63
90963 0 0 0 258 0 258
90964 0 0 0 233 0 233
90965 0 0 0 218 0 218
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
90966 0 0 0 75 0 75
90967 0 0 0 8.600000381 0 8.600000381
90968 0 0 0 7.769999981 0 7.769999981
90969 0 0 0 7.269999981 0 7.269999981
90970 0 0 0 2.5 0 2.5
90989 0 0 0 0 0 0
90993 0 0 0 0 0 0
90997 10 0 0 25 5 40
90999 0 0 0 0 0 0
91010 15 0 0 20 15 50
91013 0 0 0 14 0 14
91020 0 0 0 48 0 48
91022 15 0 0 30 16 61
91030 0 0 0 30 0 30
91034 15 0 0 0 16 31
91035 15 0 0 20 16 51
91037 15 0 0 0 16 31
91038 15 0 0 0 26 41
91040 8 4 3 15 15 45
91065 0 0 0 19 0 19
91110 5 45 15 65
91111 5 18 15 38
91112 5 0 0 40 15 60
91117 15 0 0 60 30 105
91120 7 4 4 15 15 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
91122 20 0 0 30 15 65
91132 11 0 0 25 12.5 48.5
91133 11 0 0 60 15 86
91200 3 0 0 10 5 18
91299 0 0 0 0 0 0
92002 5 0 0 15 5 25
92004 5 0 0 25 10 40
92012 5 0 0 15 5 25
92014 5 0 0 24 8 37
92015 4 0 0 14 4 22
92018 35 0 0 25 15 75
92019 30 0 0 30 20 80
92020 5 0 0 10 5 20
92025 5 0 0 12 0 17
92060 5 0 0 30 5 40
92065 0 0 0 17 0 17
92071 3 0 0 5 3 11
92072 10 0 0 45 10 65
92081 3 0 0 7 0 10
92082 3 0 0 8 0 11
92083 3 0 0 10 0 13
92100 0 0 0 20 0 20
92132 1 8 9
92133 1 10 11
92134 1 10 11
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
92136 5 7 0 5 0 17
92140 0 0 0 30 0 30
92145 2 0 0 5 0 7
92225 9 0 0 20 11 40
92226 5 0 0 10 5 20
92228 5 0 0 8 0 13
92230 0 0 0 21 0 21
92235 1 15 1 17
92240 1 20 1 22
92242 1 20 1 22
92250 1 10 1 12
92260 5 0 0 12 5 22
92265 0 0 0 36 0 36
92270 0 0 0 36 0 36
92275 10 0 0 45 16 71
92283 0 0 0 22 0 22
92284 0 0 0 36 0 36
92285 0 0 0 5 0 5
92286 5 0 0 10 0 15
92287 0 0 0 23 0 23
92310 8 0 0 25 24 57
92311 0 0 0 39 0 39
92312 0 0 0 48 0 48
92313 0 0 0 43 0 43
92314 5 0 0 20 10 35
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
92315 0 0 0 31 0 31
92316 0 0 0 41 0 41
92317 0 0 0 33 0 33
92325 0 0 0 0 0 0
92326 0 0 0 0 0 0
92340 5 0 0 10 3 18
92341 2 0 0 14 5 21
92342 3 0 0 15 5 23
92352 0 0 0 0 0 22
92353 0 0 0 0 0 24
92354 0 0 0 0 0 0
92355 0 0 0 0 0 0
92358 0 0 0 0 0 0
92370 1 0 0 10 1 12
92371 0 0 0 0 0 0
92499 0 0 0 0 0 0
92502 0 0 0 21 0 21
92504 2 0 0 5 2 9
92507 5 0 0 50 5 60
92508 2 0 0 17 3 22
92511 4 0 5 5 3 17
92512 0 0 0 0 0 13
92516 0 0 0 0 0 11
92520 10 0 0 11 10 31
92521 5 0 0 90 15 110
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
92522 5 0 0 60 20 85
92523 7 0 0 120 30 157
92524 5 0 0 60 10 75
92526 5 0 0 45 5 55
92531 0 0 0 0 0 0
92532 0 0 0 0 0 0
92533 0 0 0 0 0 0
92534 0 0 0 0 0 0
92537 5 0 0 30 5 40
92538 5 0 0 15 5 25
92540 7 0 0 60 10 77
92541 3 0 0 10 3 16
92542 3 0 0 10 3 16
92544 3 0 0 5 3 11
92545 3 0 0 5 3 11
92546 0 0 0 0 0 8
92547 0 0 0 0 0 0
92548 10 0 0 15 15 40
92550 3 0 0 10 3 16
92551 0 0 0 0 0 0
92552 0 0 0 0 0 0
92553 0 0 0 0 0 0
92555 0 0 0 0 0 0
92556 0 0 0 0 0 0
92557 3 0 0 20 5 28
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
92558 0 0 0 5 2 7
92559 0 0 0 0 0 0
92560 0 0 0 0 0 0
92561 0 0 0 0 0 0
92562 0 0 0 0 0 0
92563 0 0 0 0 0 0
92564 0 0 0 0 0 0
92565 0 0 0 0 0 0
92567 1 0 0 4 1 6
92568 1 0 0 8 1 10
92570 3 0 0 15 3 21
92571 0 0 0 0 0 0
92572 0 0 0 0 0 0
92575 0 0 0 0 0 0
92576 0 0 0 0 0 0
92577 0 0 0 0 0 0
92579 4 0 0 25 5 34
92582 0 0 0 0 0 0
92583 0 0 0 0 0 0
92584 0 0 0 0 0 0
92585 0 0 0 0 0 12
92586 0 0 0 0 0 0
92587 3 0 0 12 3 18
92588 3 0 0 16.5 3 22.5
92590 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
92591 0 0 0 0 0 0
92592 0 0 0 0 0 0
92593 0 0 0 0 0 0
92594 0 0 0 0 0 0
92595 0 0 0 0 0 0
92596 0 0 0 0 0 0
92597 7 0 0 40 13 60
92601 15 0 0 82 20 117
92602 5 0 0 50 10 65
92603 20 0 0 82 20 122
92604 5 0 0 50 10 65
92605 10 0 0 60 20 90
92606 7 0 0 60 10 77
92607 10 0 0 60 20 90
92608 0 0 0 30 0 30
92609 10 0 0 60 10 80
92610 7 0 0 35 10 52
92611 7 0 0 30 10 47
92612 10 0 0 15 7 32
92613 3 0 0 10 10 23
92614 8 0 0 15 5 28
92615 2 0 0 10 10 22
92616 10 0 0 25 10 45
92617 3 0 0 15 10 28
92618 0 0 0 30 0 30
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
92620 7 0 0 60 10 77
92621 0 0 0 15 0 15
92625 7 0 0 40 10 57
92626 7 0 0 60 10 77
92627 0 0 0 15 0 15
92630 0 0 0 0 0 0
92633 0 0 0 0 0 0
92640 4 0 0 60 5 69
92700 0 0 0 0 0 0
92920 23 1 5 68 30 127
92921 0 0 0 30 0 30
92924 23 1 5 84 30 143
92925 0 0 0 45 0 45
92928 23 1 5 76 30 135
92929 0 0 0 30 0 30
92933 23 1 5 87 30 146
92934 0 0 0 45 0 45
92937 23 1 5 67 30 126
92938 0 0 0 60 0 60
92941 23 1 5 70 40 139
92943 23 1 5 92 30 151
92944 0 0 0 60 0 60
92950 1 1 0 45 20 67
92953 14 0 0 29 31 74
92960 10 1 5 15 15 46
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
92961 50 0 0 53 20 123
92970 40 0 25 47 48 160
92971 30 0 15 49 21 115
92973 0 0 0 40 0 40
92974 0 0 0 42.5 0 42.5
92975 21 0 25 101 39 186
92977 0 0 0 0 0 0
92978 0 0 0 25 0 25
92979 0 0 0 25 0 25
92986 88 0 0 113 135 463
92987 50 0 0 150 60 329
92990 79 0 0 126 119 393
92992 0 0 0 0 0 0
92993 0 0 0 0 0 0
92997 60 0 0 155 60 275
92998 0 0 0 58 0 58
93000 0 0 0 5 1 6
93005 0 0 0 0 0 0
93010 0 0 0 5 1 6
93015 2 0 0 20 4 26
93016 2 0 0 15 2 19
93017 0 0 0 0 0 0
93018 2 0 0 5 4 11
93024 0 0 0 34 0 34
93025 5 0 0 25 10 40
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
93040 2 0 0 3 2 7
93041 0 0 0 0 0 0
93042 2 0 0 3 2 7
93050 5 2 7
93224 2 0 0 15 7 24
93225 0 0 0 0 0 0
93226 0 0 0 0 0 0
93227 2 0 0 15 7 24
93228 5 0 0 12 8 25
93229 0 0 0 0 0 0
93260 10 0 0 15 10 35
93261 10 0 0 15 10 35
93268 5 0 0 15 10 30
93270 0 0 0 0 0 0
93271 0 0 0 0 0 0
93272 5 0 0 15 10 30
93278 2 0 0 4 5 11
93279 5 0 0 10 5 20
93280 5 0 0 17 5 27
93281 5 0 0 20 5 30
93282 8 0 0 15 5 28
93283 8 0 0 15 10 33
93284 8.5 0 0 15 10 33.5
93285 5 0 0 12 5 22
93286 5 0 0 12 5 22
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
93287 7.5 0 0 13.5 5 26
93288 5 0 0 10 5 20
93289 5 0 0 15 5 25
93290 5 0 0 12 8 25
93291 5 0 0 12 5 22
93292 5 0 0 10 5 20
93293 5 0 0 10 5 20
93294 7.5 0 0 15 7.5 30
93295 7.5 0 0 22.5 7.5 37.5
93296 0 0 0 0 0 0
93297 10 0 0 24 16 50
93298 10 0 0 24 10 44
93299 0 0 0 0 0 0
93303 0 0 0 0 0 39
93304 0 0 0 0 0 34
93306 5 0 0 20 6.5 31.5
93307 5 0 0 18 5 28
93308 5 0 0 15 5 25
93312 10 0 0 30 15 55
93313 0 0 0 10 0 10
93314 5 0 0 30 15 50
93315 10 0 0 40 15 65
93316 10 0 0 20 5 35
93317 5 0 0 20 15 40
93318 10 0 0 60 15 85
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
93320 0 0 0 15 0 15
93321 0 0 0 10 0 10
93325 0 0 0 10 0 10
93350 3 0 0 20 5 28
93351 5 0 0 20 10 35
93352 0 0 0 5 0 5
93355 20 0 0 120 20 160
93451 30 3 5 30 30 98
93452 30 3 5 30 30 98
93453 30 3 5 45 30 113
93454 30 3 5 30 30 98
93455 35 3 5 40 30 113
93456 30 3 5 40 30 108
93457 35 3 5 50 30 123
93458 30 3 5 45 30 113
93459 35 3 5 50 30 123
93460 30 3 5 50 30 118
93461 35 3 5 65 35 143
93462 0 0 0 40 0 40
93463 0 0 0 30 0 30
93464 0 0 0 30 0 30
93503 5 2 5 15 10 37
93505 17 0 15 38 20 90
93530 38 0 0 95 52 185
93531 60 0 0 120 60 240
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
93532 60 0 0 175 60 295
93533 60 0 0 120 60 240
93561 15 0 15 29 19 78
93562 2 0 15 16 11 44
93563 0 0 0 25 0 25
93564 0 0 0 25 0 25
93565 0 0 0 20 0 20
93566 0 0 0 20 0 20
93567 0 0 0 15 0 15
93568 0 0 0 20 0 20
93571 0 0 0 20 0 20
93572 0 0 0 15 0 15
93580 30 0 0 120 60 210
93581 30 0 0 180 60 270
93582 23 3 15 60 45 146
93583 30 3 15 90 40 178
93590 40 3 15 135 30 223
93591 40 3 15 120 30 208
93592 60 60
93600 0 0 0 29 0 29
93602 0 0 0 21 0 21
93603 0 0 0 22 0 22
93609 0 0 0 90 0 90
93610 0 0 0 28 0 28
93612 0 0 0 30 0 30
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
93613 0 0 0 120 0 120
93615 0 0 0 17 0 17
93616 2 0 0 26 5 33
93618 0 0 0 80 0 80
93619 50 0 0 90 53 193
93620 50 0 0 120 60 230
93621 0 0 0 30 0 30
93622 0 0 0 45 0 45
93623 0 0 0 0 0 60
93624 20 0 0 60 38 118
93631 25 0 0 127 10 162
93640 60 0 0 90 60 210
93641 65 0 0 120 60 245
93642 20 0 0 60 30 110
93644 23 1 5 20 25 74
93650 50 0 0 120 60 230
93653 23 1 5 180 30 239
93654 23 1 5 240 40 309
93655 0 0 0 90 0 90
93656 23 1 5 240 40 309
93657 0 0 0 90 0 90
93660 15 0 0 50 15 80
93662 5 0 0 55 10 70
93668 15 0 0 10 10 35
93701 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
93724 15 0 0 40 10 65
93740 0 0 0 0 0 21
93745 0 0 0 0 0 0
93750 0 0 0 30 0 30
93770 0 0 0 0 0 10
93784 0 0 0 15 0 15
93786 0 0 0 0 0 0
93788 0 0 0 0 0 0
93790 0 0 0 15 0 15
93797 2 0 0 6 3 11
93798 2 0 0 7 3 12
93799 0 0 0 0 0 0
93880 5 0 0 15 5 25
93882 5 0 0 10 5 20
93886 5 0 0 17 5 27
93888 5 0 0 10 5 20
93890 10 0 0 15 10 35
93892 10 0 0 20 10 40
93893 10 0 0 20 10 40
93895 5 0 0 10 5 20
93922 3 0 0 5 2 10
93923 3 0 0 10 3 16
93924 3 0 0 13 4 20
93925 5 0 0 15 5 25
93926 5 0 0 10 5 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
93930 5 0 0 15 5 25
93931 5 0 0 10 5 20
93965 0 0 0 0 0 14
93970 3 0 0 15 5 23
93971 3 0 0 10 5 18
93975 5 0 0 20 5 30
93976 5 0 0 15 5 25
93978 5 0 0 15 5 25
93979 5 0 0 10 5 20
93980 0 0 0 0 0 41
93981 0 0 0 0 0 19
93982 2 0 0 10 2 14
93990 5 0 0 11 5 21
94002 15 0 0 30 15 60
94003 10 0 0 20 10 40
94004 10 0 0 15 10 35
94005 15 0 0 25 15 55
94010 0 0 0 5 2 7
94011 20 0 0 30 20 70
94012 20 0 0 60 25 105
94013 0 0 0 7.5 0 7.5
94014 0 0 2 20 0 22
94015 0 0 0 0 0 0
94016 2 0 0 20 0 22
94060 3 0 0 7.5 3 13.5
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
94070 0 0 0 15 0 15
94150 5 0 0 4 3 12
94200 0 0 0 0 0 15
94250 0 0 0 0 0 15
94375 5 0 0 7 5 17
94400 0 0 0 0 0 21
94450 0 0 0 0 0 21
94452 10 0 0 10 10 30
94453 5 0 0 6 12 23
94610 0 0 0 20 0 20
94620 15 0 0 15 10 40
94621 15 0 0 30 20 65
94640 0 0 0 0 0 0
94642 0 0 0 0 0 0
94644 0 0 0 0 0 0
94645 0 0 0 0 0 0
94660 10 0 0 20 10 40
94662 0 0 0 47 0 47
94664 0 0 0 0 0 0
94680 0 0 0 0 0 18
94681 0 0 0 0 0 17
94690 0 0 0 0 0 15
94726 5 0 0 5 5 15
94727 5 0 0 5 5 15
94728 5 0 0 5 5 15
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
94729 0 0 0 5 0 5
94750 0 0 0 0 0 18
94760 0 0 0 0 0 0
94761 0 0 0 0 0 0
94762 0 0 0 0 0 0
94770 5 0 0 5 3 13
94772 0 0 0 0 0 0
94774 0 0 0 0 0 0
94775 0 0 0 0 0 0
94776 0 0 0 0 0 0
94777 0 0 0 0 0 0
94780 2 0 0 10 4 16
94781 0 0 0 5 0 5
94799 0 0 0 0 0 0
95004 0.125 0 0 0.125 0.125 0.375
95012 0 0 0 0 0 0
95017 0.560000002 0 0 0.74 0.56 1.860000002
95018 1.67 0 0 1.67 1.67 5.01
95024 0 0 0 0.416 0.833 1.249
95027 0.222 0 0 0.222 0.222 0.666
95028 0 0 0 0 0 0
95044 0 0 0 0 0 0
95052 0 0 0 0 0 0
95056 0 0 0 0 0 0
95060 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
95065 0 0 0 0 0 0
95070 0 0 0 0 0 0
95071 0 0 0 0 0 0
95076 7 0 0 30 5 42
95079 0 0 0 30 0 30
95115 0 0 0 0 0 0
95117 0 0 0 0 0 0
95120 0 0 0 0 0 0
95125 0 0 0 0 0 0
95130 0 0 0 0 0 0
95131 0 0 0 0 0 0
95132 0 0 0 0 0 0
95133 0 0 0 0 0 0
95134 0 0 0 0 0 0
95144 3 3
95145 0 0 0 2 0 2
95146 0 0 0 2 0 2
95147 0 0 0 2 0 2
95148 0 0 0 2 0 2
95149 0 0 0 2 0 2
95165 3 3
95170 0 0 0 2 0 2
95180 0 0 0 0 0 50
95199 0 0 0 0 0 0
95250 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
95251 0 0 0 30 0 30
95782 15 0 0 45 10 70
95783 20 0 0 50 15 85
95800 15 0 0 20 15 50
95801 10 0 0 15 15 40
95803 15 0 0 20 15 50
95805 15 0 0 20 15 50
95806 10 0 0 25 15 50
95807 15 0 0 25 15 55
95808 15 0 0 20 15 50
95810 15 0 0 36.5 15 66.5
95811 15 0 0 35 15 65
95812 5 15 5 25
95813 5 25 5 35
95816 5 0 0 15 6 26
95819 5 0 0 15 6 26
95822 5 0 0 18 10 33
95824 0 0 0 0 0 15
95827 0 0 0 0 0 30
95829 0 0 0 87 0 87
95830 0 0 0 19 0 19
95831 0 0 0 0 0 16
95832 0 0 0 0 0 16
95833 0 0 0 0 0 19
95834 0 0 0 0 0 22
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
95851 0 0 0 0 0 16
95852 0 0 0 0 0 14
95857 0 0 0 24 0 24
95860 10 0 0 20 10 40
95861 10 0 0 29 10 49
95863 10 0 0 40 11 61
95864 10 0 0 50 13.5 73.5
95865 10 0 0 15 6.5 31.5
95866 10 0 0 15 10 35
95867 10 0 0 15 10 35
95868 10 0 0 20 10 40
95869 10 0 0 15 10 35
95870 10 0 0 15 10 35
95872 15 0 0 60 20 95
95873 0 0 0 20 0 20
95874 0 0 0 20 0 20
95875 10 0 0 30 10 50
95885 0 0 0 15 0 15
95886 0 0 0 30 0 30
95887 0 0 0 20 0 20
95905 0 0 0 5 0 5
95907 10 0 0 15 10 35
95908 10 0 0 22 10 42
95909 10 0 0 30 11 51
95910 13 0 0 40 12.5 65.5
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
95911 15 0 0 50 15 80
95912 15 0 0 60 15 90
95913 15 0 0 70 20 105
95921 8 0 0 15 10 33
95922 10 0 0 20 10 40
95923 5 0 0 15 10 30
95924 15 0 0 30 15 60
95925 6.5 0 0 15 10 31.5
95926 6.5 0 0 15 10 31.5
95927 6.5 0 0 15 10 31.5
95928 15 0 0 40 10 65
95929 15 0 0 40 10 65
95930 5 0 0 10 10 25
95933 0 0 0 25 0 25
95937 5 0 0 12 5 22
95938 10 0 0 20 10 40
95939 15 0 0 30 15 60
95940 0 0 0 15 0 15
95941 0 0 0 0 0 0
95950 10 0 0 33 10 53
95951 30 0 0 60 60 150
95953 10 0 0 45 15 70
95954 5 0 0 60 5 70
95955 0 0 0 35 0 35
95956 15 0 0 60 30 105
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
95957 15 30 10 55
95958 0 0 0 79 0 79
95961 0 0 0 0 0 65
95962 0 0 0 0 0 70
95965 20 0 0 180 30 230
95966 15 0 0 75 0 90
95967 0 0 0 60 0 60
95970 0 0 0 19 0 19
95971 8 20 5 33
95972 8 23 5 36
95974 30 0 0 60 20 110
95975 0 0 0 30 0 30
95978 5 0 0 60 5 70
95979 0 0 0 30 0 30
95980 3 0 0 24 5 32
95981 2 0 0 10 5 17
95982 2 0 0 17 5 24
95991 10 0 0 20 7 37
95992 0 0 0 20 10 30
95999 0 0 0 0 0 0
96000 30 0 0 129 157.5 316.5
96001 30 0 0 150 170 350
96002 15 0 0 60 42.5 117.5
96003 15 0 0 35 30 80
96004 0 0 0 70 0 70
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
96020 10 0 0 60 10 80
96040 0 0 0 0 0 0
96101 7 0 0 60 0 67
96102 3 0 0 15 5 23
96103 8 0 0 8 14 30
96105 4 0 0 60 5 69
96110 0 0 0 0 0 0
96111 5 0 0 60 30 95
96116 7 0 0 60 0 67
96118 7 0 0 60 0 67
96119 3 0 0 15 5 23
96120 8 0 0 8 14 30
96125 7 0 0 60 0 67
96150 3 0 0 15 5 23
96151 4 0 0 15 5 24
96152 4 0 0 15 5 24
96153 1 0 0 3 1 5
96154 4 0 0 15 20 39
96155 4 0 0 15 5 24
96160 0
96161 0
96360 2 0 0 3 2 7
96361 0 0 0 3 0 3
96365 2 0 0 5 2 9
96366 0 0 0 5 0 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
96367 1 0 0 5 0 6
96368 1 0 0 5 0 6
96369 5 0 0 10 2 17
96370 0 0 0 5 0 5
96371 0 0 0 0 0 0
96372 2 0 0 3 2 7
96373 0 0 0 5 2 7
96374 2 0 0 5 2 9
96375 1 0 0 3 0 4
96376 0 0 0 0 0 0
96379 0 0 0 0 0 0
96401 4 0 0 3 2 9
96402 4 0 0 3 2 9
96405 15 0 0 10 5 30
96406 10 0 0 15 5 30
96409 4 0 0 5 2 11
96411 3 0 0 4 0 7
96413 4 0 0 7 2 13
96415 0 0 0 5 0 5
96416 4 0 0 4 2 10
96417 2 0 0 6 0 8
96420 0 0 0 5 2 7
96422 0 0 0 5 2 7
96423 0 0 0 5 2 7
96425 0 0 0 5 2 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
96440 16 0 25 38 18 97
96446 5 0 0 7 5 17
96450 20 0 25 33 18 96
96521 4 0 0 4 2 10
96522 4 0 0 4 2 10
96523 2 0 0 0 0 2
96542 0 0 0 0 0 75
96549 0 0 0 0 0 0
96567 0 0 0 0 0 0
96570 0 0 0 30 0 30
96571 0 0 0 15 0 15
96900 0 0 0 0 0 0
96902 5 0 0 8 0 13
96904 10 0 0 60 10 80
96910 0 0 0 0 0 0
96912 0 0 0 0 0 0
96920 7 0 0 23 5 35
96921 7 0 0 30 5 42
96922 7 0 0 45 5 57
96931 3 25 28
96932 0
96933 3 25 28
96934 25 25
96935 0
96936 25 25
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
96999 0 0 0 0 0 0
97001 4 0 0 30 8 42
97002 2 0 0 18 5 25
97003 7 0 0 45 5 57
97004 3 0 0 30 2 35
97005 0 0 0 0 0 0
97006 0 0 0 0 0 0
97010 1 0 0 3 1 5
97012 1 0 0 13 1 15
97014 1 0 0 11 1 13
97016 2 0 0 14 2 18
97018 1 0 0 11 1 13
97022 1 0 0 13 1 15
97024 1 0 0 13 1 15
97026 1 0 0 8 1 10
97028 1 0 0 15 2 18
97032 1 0 0 11 2 14
97033 1 0 0 13 2 16
97034 1 0 0 9 2 12
97035 1 0 0 12 2 15
97036 1 0 0 15 2 18
97039 0 0 0 0 0 0
97110 1 0 0 15 2 18
97112 1 0 0 15 2 18
97113 1 0 0 15 2 18
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
97116 1 0 0 12 2 15
97124 1 0 0 15 2 18
97139 0 0 0 0 0 0
97140 2 0 0 14 2 18
97150 0 0 0 10 0 10
97161 10 30 15 55
97162 10 30 15 55
97163 10 30 15 55
97164 5 20 10 35
97165 10 45 10 65
97166 10 45 10 65
97167 10 45 10 65
97168 5 30 10 45
97530 1 0 0 15 2 18
97532 1 22 2 25
97533 1 0 0 20 2 23
97535 1 0 0 15 2 18
97537 1 0 0 15 2 18
97542 1 0 0 15 2 18
97545 0 0 0 120 0 120
97546 0 0 0 0 0 0
97597 5 0 0 14 5 24
97598 0 0 0 14 0 14
97605 3 0 0 20 5 28
97606 3 0 0 30 5 38
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
97607 3 0 0 15 5 23
97608 3 0 0 15 5 23
97610 4 0 0 12 2 18
97750 1 0 0 15 2 18
97755 4.5 0 0 15 12 31.5
97760 2 0 0 14 2 18
97761 2 0 0 14 2 18
97762 2 0 0 14 2 18
97799 0 0 0 0 0 0
97802 1 0 0 15 1 17
97803 1 0 0 15 1 17
97804 2 0 0 6 2 10
97810 3 0 0 15 3 21
97811 0 0 0 15 0 15
97813 3 0 0 15 3 21
97814 0 0 0 15 0 15
98925 1 1 0 10 2 14
98926 1 1 0 15 2 19
98927 1 1 0 20 2 24
98928 1 1 0 25 2 29
98929 1 1 0 30 2 34
98940 4 0 0 7 4 15
98941 5 0 0 10 5 20
98942 6 0 0 12 5 23
98943 4 0 0 8 4 16
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
98960 0 0 0 0 0 0
98961 0 0 0 0 0 0
98962 0 0 0 0 0 0
98966 1 0 0 8 4 13
98967 1 0 0 15 5 21
98968 1 0 0 25 10 36
98969 0 0 0 0 0 0
99000 0 0 0 0 0 0
99001 0 0 0 0 0 0
99002 0 0 0 0 0 0
99024 0 0 0 0 0 0
99026 0 0 0 0 0 0
99027 0 0 0 0 0 0
99050 0 0 0 0 0 0
99051 0 0 0 0 0 0
99053 0 0 0 0 0 0
99056 0 0 0 0 0 0
99058 0 0 0 0 0 0
99060 0 0 0 0 0 0
99070 0 0 0 0 0 0
99071 0 0 0 0 0 0
99075 0 0 0 0 0 0
99078 0 0 0 0 0 0
99080 0 0 0 0 0 0
99082 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
99090 0 0 0 0 0 0
99091 5 0 0 30 5 40
99100 0 0 0 0 0 0
99116 0 0 0 0 0 0
99135 0 0 0 0 0 0
99140 0 0 0 0 0 0
99143 15 0 0 30 10 55
99144 15 0 0 20 10 45
99145 0 0 0 15 0 15
99148 20 0 0 30 15 65
99149 15 0 0 20 11 46
99150 0 0 0 15 0 15
99151 15 15 30
99152 12 12
99153 0 0
99155 15 15 15 45
99156 10 15 9 34
99157 15 15
99170 0 0 0 50 0 50
99172 0 0 0 0 0 0
99173 0 0 0 0 0 0
99174 0 0 0 0 0 0
99175 0 0 0 0 0 0
99177 0 0 0 0 0 0
99183 10 0 0 40 10 60
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
99184 30 0 0 60 20 110
99188 2 0 0 5 2 9
99190 0 0 0 0 0 0
99191 0 0 0 0 0 0
99192 0 0 0 0 0 0
99195 0 0 0 0 0 0
99199 0 0 0 0 0 0
99201 2 0 0 10 5 17
99202 2 0 0 15 5 22
99203 4 0 0 20 5 29
99204 5 0 0 30 10 45
99205 7 0 0 45 15 67
99211 0 0 0 5 2 7
99212 2 0 0 10 4 16
99213 3 0 0 15 5 23
99214 5 0 0 25 10 40
99215 5 0 0 35 15 55
99217 10 0 0 30 15 55
99218 10 0 0 30 10 50
99219 10 0 0 40 14.5 64.5
99220 15 0 0 45 15 75
99221 10 0 0 30 10 50
99222 15 0 0 40 20 75
99223 15 0 0 55 20 90
99224 5 0 0 10 5 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
99225 10 0 0 20 10 40
99226 10 0 0 30 15 55
99231 5 0 0 10 5 20
99232 10 0 0 20 10 40
99233 10 0 0 30 15 55
99234 14 0 0 40 15 69
99235 14 0 0 50 19.5 83.5
99236 19 0 0 55 20 94
99238 8 0 0 20 10 38
99239 10 0 0 30 15 55
99241 5 0 0 15 5 25
99242 5 0 0 25 10 40
99243 5 0 0 28 7 40
99244 10 0 0 40 15 65
99245 10 0 0 60 20 90
99251 5 0 0 10 5 20
99252 5 0 0 25 10 40
99253 10 0 0 30 15 55
99254 15 0 0 45 20 80
99255 20 0 0 60 25 105
99281 2 0 0 7 4 13
99282 3 0 0 10 5 18
99283 5 0 0 18 7 30
99284 5 0 0 25 10 40
99285 8 0 0 40 15 63
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
99288 0 0 0 0 0 0
99291 15 0 0 40 15 70
99292 0 0 0 30 0 30
99304 10 0 0 23 10 43
99305 11 0 0 33 13 57
99306 15 0 0 45 20 80
99307 5 0 0 10 5 20
99308 7 0 0 15 9 31
99309 10 0 0 25 10 45
99310 15 0 0 35 20 70
99315 10 0 0 20 10 40
99316 14 0 0 25 15 54
99318 10 0 0 27 10 47
99324 6.5 0 0 20 10 36.5
99325 10 0 0 30 12 52
99326 15 0 0 45 17 77
99327 15 0 0 60 25 100
99328 15 0 0 75 30 120
99334 5 0 0 15 10 30
99335 9 0 0 25 10 44
99336 10 0 0 40 15 65
99337 15 0 0 60 20 95
99339 10 0 0 20 10 40
99340 15 0 0 30 15 60
99341 6 0 0 20 10 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
99342 10 0 0 30 12 52
99343 15 0 0 45 17 77
99344 15 0 0 60 25 100
99345 15 0 0 75 30 120
99347 5 0 0 15 10 30
99348 9 0 0 25 10 44
99349 10 0 0 40 15 65
99350 15 0 0 75 20 110
99354 60 60
99355 0 0 0 30 0 30
99356 0 0 0 60 0 60
99357 0 0 0 30 0 30
99358 60 60
99359 30 30
99360 30 0 0 0 0 30
99363 0 0 0 50 0 50
99364 0 0 0 20 0 20
99366 5 0 0 30 5 40
99367 5 0 0 30 5 40
99368 5 0 0 30 5 40
99374 5 0 0 20 9 34
99375 10 0 0 32 15 57
99377 5 0 0 15 5 25
99378 10 0 0 38 10 58
99379 5 0 0 20 10 35
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
99380 8.5 0 0 36 10 54.5
99381 5 0 0 20 5 30
99382 7 0 0 20 5 32
99383 6 0 0 20 5 31
99384 8 0 0 25 7 40
99385 10 0 0 30 10 50
99386 10 0 0 40 10 60
99387 10 0 0 40 15 65
99391 4 0 0 17 5 26
99392 5 0 0 20 5 30
99393 4.5 0 0 20 5 29.5
99394 5 0 0 25 5 35
99395 5 0 0 30 10 45
99396 5 0 0 30 11 46
99397 5 0 0 30 10 45
99401 0 0 0 15 0 15
99402 0 0 0 30 0 30
99403 0 0 0 45 0 45
99404 0 0 0 60 0 60
99406 0 0 0 7 0 7
99407 0 0 0 15 0 15
99408 0 0 0 20 0 20
99409 0 0 0 40 0 40
99411 10 0 0 30 5 45
99412 19 0 0 60 10 89
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
99415 0 0 0 0 0 0
99416 0 0 0 0 0 0
99420 0 0 0 0 0 0
99429 0 0 0 0 0 0
99441 1 0 0 8 4 13
99442 1 0 0 15 5 21
99443 1 0 0 20 10 31
99444 0 0 0 0 0 0
99446 3 0 0 8 5 16
99447 3 0 0 15 5 23
99448 5 0 0 25 5 35
99449 9 0 0 31 10 50
99450 0 0 0 0 0 0
99455 0 0 0 0 0 0
99456 0 0 0 0 0 0
99460 10 0 0 30 10 50
99461 2 0 0 28 3 33
99462 5 0 0 10 5 20
99463 5 0 0 35 15 55
99464 15 0 0 25 15 55
99465 5 0 0 45 10 60
99466 15 0 0 60 20 95
99467 0 0 0 30 0 30
99468 45 0 0 180 48.8 273.8
99469 0 0 0 128 0 128
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
99471 30 0 0 180 30 240
99472 20 0 0 90 30 140
99475 30 0 0 105 30 165
99476 20 0 0 65 20 105
99477 30 0 0 77.5 40 147.5
99478 10 0 0 30 20 60
99479 10 0 0 30 15 55
99480 15 0 0 30 15 60
99485 15 0 0 20 12 47
99486 0 0 0 25 0 25
99487 26 26
99489 13 13
99490 0 0 0 15 0 15
99495 0 0 0 40 0 40
99496 0 0 0 50 0 50
99497 5 0 0 30 10 45
99498 0 0 0 30 0 30
99499 0 0 0 0 0 0
99500 0 0 0 0 0 0
99501 0 0 0 0 0 0
99502 0 0 0 0 0 0
99503 0 0 0 0 0 0
99504 0 0 0 0 0 0
99505 0 0 0 0 0 0
99506 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
99507 0 0 0 0 0 0
99509 0 0 0 0 0 0
99510 0 0 0 0 0 0
99511 0 0 0 0 0 0
99512 0 0 0 0 0 0
99600 0 0 0 0 0 0
99601 0 0 0 0 0 0
99602 0 0 0 0 0 0
99605 0 0 0 0 0 0
99606 0 0 0 0 0 0
99607 0 0 0 0 0 0
A4224 0 0 0 0 0 0
A4225 0 0 0 0 0 0
A4467 0 0 0 0 0 0
A4553 0 0 0 0 0 0
A9285 0 0 0 0 0 0
A9286 0 0 0 0 0 0
A9515 0 0 0 0 0 0
A9587 0 0 0 0 0 0
A9588 0 0 0 0 0 0
A9597 0 0 0 0 0 0
A9598 0 0 0 0 0 0
D0414 0 0 0 0 0 0
D0600 0 0 0 0 0 0
D1575 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
D4346 0 0 0 0 0 0
D6081 0 0 0 0 0 0
D6085 0 0 0 0 0 0
D9311 0 0 0 0 0 0
D9991 0 0 0 0 0 0
D9992 0 0 0 0 0 0
D9993 0 0 0 0 0 0
D9994 0 0 0 0 0 0
G0101 2 0 0 10 4 16
G0102 0 0 0 5 2 7
G0104 7 0 0 17 8 32
G0105 14 3 5 25 15 62
G0106 0 0 0 24 0 24
G0108 1 0 0 15 1 17
G0109 2 0 0 5 2 9
G0117 2 0 0 10 4 16
G0118 0 0 0 5 2 7
G0120 0 0 0 24 0 24
G0121 14 3 5 25 15 62
G0122 0 0 0 0 0 38
G0124 0 0 0 0 0 16
G0127 4 1 0 5 2 12
G0130 5 0 0 5 10 20
G0141 0 0 0 0 0 16
G0166 0 0 0 5 2 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
G0168 2 0 0 10 4 16
G0179 2 0 0 10 4 16
G0180 3 0 0 15 5 23
G0181 10 0 0 32 15 57
G0182 10 0 0 38 10 58
G0202 2 6 2 10
G0204 5 12 7 24
G0206 5 10 6 21
G0245 2 0 0 15 5 22
G0246 2 0 0 10 4 16
G0247 5 1 1 10 7 24
G0250 0 0 0 5 2 7
G0268 5 2 0 10 2 19
G0270 1 0 0 15 1 17
G0271 2 0 0 6 2 10
G0278 0 0 0 5 0 5
G0279 0 0 0 8 0 8
G0281 1 0 0 11 1 13
G0283 1 0 0 11 1 13
G0289 0 0 0 20.5 0 20.5
G0296 2 15 1 18
G0297 5 15 5 25
G0329 1 0 0 13 1 15
G0341 0 0 0 75 77 152
G0342 40 10 15 90 25 238
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
G0343 75 0 0 180 30 588
G0364 0 0 0 5 0 5
G0365 0 0 0 20 0 20
G0372 0 0 0 5 2 7
G0389 0 0 0 0 0 18
G0396 0 0 0 20 0 20
G0397 0 0 0 40 0 40
G0402 5 0 0 30 10 45
G0403 0 0 0 5 2 7
G0405 0 0 0 4 1 5
G0406 5 0 0 10 5 20
G0407 10 0 0 20 10 40
G0408 10 0 0 30 15 55
G0412 40 15 20 120 20 388
G0413 40 25 20 60 25 393
G0414 40 15 20 120 25 443
G0415 40 40 20 150 30 543
G0416 120 120
G0420 1 0 0 15 1 17
G0421 2 0 0 6 2 10
G0422 0 0 0 60 0 60
G0423 0 0 0 60 0 60
G0424 2 0 0 7 3 12
G0425 10 0 0 30 10 50
G0426 15 0 0 40 20 75
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
G0427 15 0 0 55 20 90
G0429 15 0 0 30 10 55
G0436 0 0 0 7 0 7
G0437 0 0 0 15 0 15
G0438 5 0 0 30 10 45
G0439 5 0 0 25 10 40
G0442 0 0 0 15 0 15
G0443 0 0 0 15 0 15
G0444 0 0 0 15 0 15
G0445 0 0 0 30 0 30
G0446 0 0 0 15 0 15
G0447 0 0 0 15 0 15
G0453 0 0 0 15 0 15
G0454 0 0 0 5 2 7
G0455 3 0 0 15 5 23
G0459 5 0 0 25 23 53
G0464 0 0 0 0 0 0
G0473 2 0 0 6 2 10
G0491 0 0 0 0 0 0
G0492 0 0 0 0 0 0
G0493 0 0 0 0 0 0
G0494 0 0 0 0 0 0
G0495 0 0 0 0 0 0
G0496 0 0 0 0 0 0
G0499 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
G0500 12 12
G0501 0 0 0 0 0 0
G0502 40 40
G0503 36 36
G0504 18 18
G0505 15 50 20 85
G0506 5 16 7.5 28.5
G0507 15 15
G0508 0 0 0 60 0 60
G0509 0 0 0 50 0 50
G6001 0 0 0 0 0 18
G6002 0 0 0 9 0 9
G6005 0 0 0 0 0 0
G6006 0 0 0 0 0 0
G6007 0 0 0 0 0 0
G6008 0 0 0 0 0 0
G6009 0 0 0 0 0 0
G6010 0 0 0 0 0 0
G6011 0 0 0 0 0 0
G6012 0 0 0 0 0 0
G6013 0 0 0 0 0 0
G6014 0 0 0 0 0 0
G6015 0 0 0 0 0 0
G6016 0 0 0 0 0 0
G6017 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
G9157 15 0 0 13 15 43
G9187 0 0 0 5 2 7
G9481 2 0 0 10 5 17
G9482 2 0 0 15 5 22
G9483 4 0 0 20 5 29
G9484 5 0 0 30 10 45
G9485 7 0 0 45 15 67
G9486 2 0 0 10 4 16
G9487 3 0 0 15 5 23
G9488 5 0 0 25 10 40
G9489 5 0 0 35 15 55
G9490 0 0 0 5 2 7
G9678 0 0 0 0 0 0
G9685 15 0 0 55 20 90
G9686 5 0 0 25 10 40
G9687 0 0 0 0 0 0
G9688 0 0 0 0 0 0
G9689 0 0 0 0 0 0
G9690 0 0 0 0 0 0
G9691 0 0 0 0 0 0
G9692 0 0 0 0 0 0
G9693 0 0 0 0 0 0
G9694 0 0 0 0 0 0
G9695 0 0 0 0 0 0
G9696 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
G9697 0 0 0 0 0 0
G9698 0 0 0 0 0 0
G9699 0 0 0 0 0 0
G9700 0 0 0 0 0 0
G9701 0 0 0 0 0 0
G9702 0 0 0 0 0 0
G9703 0 0 0 0 0 0
G9704 0 0 0 0 0 0
G9705 0 0 0 0 0 0
G9706 0 0 0 0 0 0
G9707 0 0 0 0 0 0
G9708 0 0 0 0 0 0
G9709 0 0 0 0 0 0
G9710 0 0 0 0 0 0
G9711 0 0 0 0 0 0
G9712 0 0 0 0 0 0
G9713 0 0 0 0 0 0
G9714 0 0 0 0 0 0
G9715 0 0 0 0 0 0
G9716 0 0 0 0 0 0
G9717 0 0 0 0 0 0
G9718 0 0 0 0 0 0
G9719 0 0 0 0 0 0
G9720 0 0 0 0 0 0
G9721 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
G9722 0 0 0 0 0 0
G9723 0 0 0 0 0 0
G9724 0 0 0 0 0 0
G9725 0 0 0 0 0 0
G9726 0 0 0 0 0 0
G9727 0 0 0 0 0 0
G9728 0 0 0 0 0 0
G9729 0 0 0 0 0 0
G9730 0 0 0 0 0 0
G9731 0 0 0 0 0 0
G9732 0 0 0 0 0 0
G9733 0 0 0 0 0 0
G9734 0 0 0 0 0 0
G9735 0 0 0 0 0 0
G9736 0 0 0 0 0 0
G9737 0 0 0 0 0 0
G9738 0 0 0 0 0 0
G9739 0 0 0 0 0 0
G9740 0 0 0 0 0 0
G9741 0 0 0 0 0 0
G9742 0 0 0 0 0 0
G9743 0 0 0 0 0 0
G9744 0 0 0 0 0 0
G9745 0 0 0 0 0 0
G9746 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
G9747 0 0 0 0 0 0
G9748 0 0 0 0 0 0
G9749 0 0 0 0 0 0
G9750 0 0 0 0 0 0
G9751 0 0 0 0 0 0
G9752 0 0 0 0 0 0
G9753 0 0 0 0 0 0
G9754 0 0 0 0 0 0
G9755 0 0 0 0 0 0
G9756 0 0 0 0 0 0
G9757 0 0 0 0 0 0
G9758 0 0 0 0 0 0
G9759 0 0 0 0 0 0
G9760 0 0 0 0 0 0
G9761 0 0 0 0 0 0
G9762 0 0 0 0 0 0
G9763 0 0 0 0 0 0
G9764 0 0 0 0 0 0
G9765 0 0 0 0 0 0
G9766 0 0 0 0 0 0
G9767 0 0 0 0 0 0
G9768 0 0 0 0 0 0
G9769 0 0 0 0 0 0
G9770 0 0 0 0 0 0
G9771 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
G9772 0 0 0 0 0 0
G9773 0 0 0 0 0 0
G9774 0 0 0 0 0 0
G9775 0 0 0 0 0 0
G9776 0 0 0 0 0 0
G9777 0 0 0 0 0 0
G9778 0 0 0 0 0 0
G9779 0 0 0 0 0 0
G9780 0 0 0 0 0 0
G9781 0 0 0 0 0 0
G9782 0 0 0 0 0 0
G9783 0 0 0 0 0 0
G9784 0 0 0 0 0 0
G9785 0 0 0 0 0 0
G9786 0 0 0 0 0 0
G9787 0 0 0 0 0 0
G9788 0 0 0 0 0 0
G9789 0 0 0 0 0 0
G9790 0 0 0 0 0 0
G9791 0 0 0 0 0 0
G9792 0 0 0 0 0 0
G9793 0 0 0 0 0 0
G9794 0 0 0 0 0 0
G9795 0 0 0 0 0 0
G9796 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
G9797 0 0 0 0 0 0
G9798 0 0 0 0 0 0
G9799 0 0 0 0 0 0
G9800 0 0 0 0 0 0
G9801 0 0 0 0 0 0
G9802 0 0 0 0 0 0
G9803 0 0 0 0 0 0
G9804 0 0 0 0 0 0
G9805 0 0 0 0 0 0
G9806 0 0 0 0 0 0
G9807 0 0 0 0 0 0
G9808 0 0 0 0 0 0
G9809 0 0 0 0 0 0
G9810 0 0 0 0 0 0
G9811 0 0 0 0 0 0
G9812 0 0 0 0 0 0
G9813 0 0 0 0 0 0
G9814 0 0 0 0 0 0
G9815 0 0 0 0 0 0
G9816 0 0 0 0 0 0
G9817 0 0 0 0 0 0
G9818 0 0 0 0 0 0
G9819 0 0 0 0 0 0
G9820 0 0 0 0 0 0
G9821 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
G9822 0 0 0 0 0 0
G9823 0 0 0 0 0 0
G9824 0 0 0 0 0 0
G9825 0 0 0 0 0 0
G9826 0 0 0 0 0 0
G9827 0 0 0 0 0 0
G9828 0 0 0 0 0 0
G9829 0 0 0 0 0 0
G9830 0 0 0 0 0 0
G9831 0 0 0 0 0 0
G9832 0 0 0 0 0 0
G9833 0 0 0 0 0 0
G9834 0 0 0 0 0 0
G9835 0 0 0 0 0 0
G9836 0 0 0 0 0 0
G9837 0 0 0 0 0 0
G9838 0 0 0 0 0 0
G9839 0 0 0 0 0 0
G9840 0 0 0 0 0 0
G9841 0 0 0 0 0 0
G9842 0 0 0 0 0 0
G9843 0 0 0 0 0 0
G9844 0 0 0 0 0 0
G9845 0 0 0 0 0 0
G9846 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
G9847 0 0 0 0 0 0
G9848 0 0 0 0 0 0
G9849 0 0 0 0 0 0
G9850 0 0 0 0 0 0
G9851 0 0 0 0 0 0
G9852 0 0 0 0 0 0
G9853 0 0 0 0 0 0
G9854 0 0 0 0 0 0
G9855 0 0 0 0 0 0
G9856 0 0 0 0 0 0
G9857 0 0 0 0 0 0
G9858 0 0 0 0 0 0
G9859 0 0 0 0 0 0
G9860 0 0 0 0 0 0
G9861 0 0 0 0 0 0
G9862 0 0 0 0 0 0
P3001 0 0 0 0 0 16
Q0035 0 0 0 5 2 7
Q0091 0 0 0 16 0 16
