As of 2025, CPT 99360 remains the designated code for physician standby or detention time without direct patient contact. It’s critical for coders, billers, and revenue cycle professionals to understand how it applies under current payer policies and documentation expectations.
Introduction to CPT 99360 in 2025
In 2025, the focus on cost‑control and payer enforcement continues. CPT 99360 is used when a physician or qualified provider is requested to stand by—remaining close and immediately available—but not seeing other patients. Importantly, this coverage is seldom reimbursed by Medicare or major payers. In this article, you’ll learn eligibility criteria, payer nuances, documentation requirements, and best practices for handling CPT 99360.
What CPT 99360 Represents
CPT 99360 covers periods of prolonged attendance without direct face‑to‑face contact during procedures, such as operative standby, frozen section support, or high‑risk delivery monitoring (billed per 30‑minute increment). It applies only when no other patients are seen and no overlapping critical care (e.g., CPT 99291/99292) is provided :contentReference[oaicite:1]{index=1}.
2025 Payer Policies & Reimbursement
Medicare and CMS Guidelines
CMS policy continues to treat standby services as bundled into facility payment; CPT 99360 is **not reimbursed** under Part B. Medicare sees these services as part of the inpatient or outpatient hospital payment and does not pay separately :contentReference[oaicite:2]{index=2}.
Major Private Payers (e.g. UnitedHealthcare)
UnitedHealthcare’s 2025 policy reaffirms that CPT 99360 is not separately reimbursable under both Medicare Advantage and Commercial benefit plans. If the standby physician later performs a billable service (e.g. frozen section interpretation), that activity must be reported under the appropriate CPT code—**not 99360** :contentReference[oaicite:3]{index=3}.
Documentation Requirements for CPT 99360
Accurate documentation is essential even if reimbursement is unlikely:
- The procedure requiring full‑time attendance.
- Medical necessity for immediate availability.
- A log of tasks performed (if any).
- Total time spent strictly on standby (per 30‑minute blocks).
- Separate note if anesthesia oversight or unavailability of supervising staff applies :contentReference[oaicite:4]{index=4}.
Impact on Billing and Coding Workflow
Since payers typically disallow 99360, coders should:
- Avoid including it in final billing unless facility policy mandates internal tracking.
- Ensure no overlap with critical care codes (CPT 99291/99292) which cannot be billed concurrently with 99360 :contentReference[oaicite:5]{index=5}.
- Use modifiers correctly when a billable service occurs at the end of standby (e.g. 25 or distinct‑procedure codes).
When to Use CPT 99360
Only use this code for internal tracking or facility reporting. In most cases, standbys are part of bundled facility payments and should not be billed to payers who deny standalone standby codes.
FAQs about CPT 99360
Is CPT 99360 reimbursed by Medicare in 2025?
No. Medicare considers standby service part of facility payment and does **not** reimburse CPT 99360 under Part B in 2025 :contentReference[oaicite:6]{index=6}.
Can a provider bill CPT 99360 and critical care on same day?
No. If critical care codes 99291/99292 are reported, any overlapping standby time using 99360 is disallowed. Separate non‑critical care services may be billed if properly documented and distinct.
What if the standby ends with direct service (e.g., frozen section review)?
Code only the service performed—such as frozen section interpretation (e.g. CPT 88331)—instead of CPT 99360, even if standby occurred earlier.
Best Practices for 2025 Coding Teams
- Train staff to recognize when standby time occurs and how it should be documented internally.
- Regularly review payer policy updates—CMS and payers like UHC—since 2025 policies continue to disallow standalone payment.
- Audit claims to ensure no inadvertent billing of CPT 99360 to Medicare or major commercial payers.
- In facilities that require resource tracking, develop internal processes separate from claims submission.
Conclusion
CPT 99360 remains the official code for physician standby or detention time. However, as of 2025, Medicare and most major payers do not reimburse it independently. Therefore, proper documentation and internal tracking are crucial—but avoid submitting it on claims where payers will routinely deny standalone standby charges. Keeping your team informed and compliant ensures clean billing, fewer denials, and better revenue cycle results.
For more on related codes and denial management, see our articles on standby service guidelines, ICD‑10 coding tips, and common denial reasons.