What's with MCR and code 99354

I submitted a claim with the primary E&M of 99350, a home visit for diabetes, hypertension, gouty arthritis and osteoarthritis, and sciatica. In the course of the visit, I discovered she had a lower urinary tract infection. Investigation required additional time and effort, along with counselling for urinary tract hygiene.
I added the procedure code 99354-25.
Medicare paid the primary E&M but denied the extended time code despite the documentation showed an hour and 43 minutes for the visit, clearly above the threshold to justify the extended visit code.
This isn't the first time they've denied this code. For the past three years, inclusion of this code meant an automatic request for the records and delayed processing an additional 42 days. In the past I just accepted the payment for the primary code and walked away because the additional payment wasn't worth the time spent appealing the denial of 99354. Seems to me to be a policy of CMS to discourage claiming payment for the time their public rhetoric encorages.
Please explain /comment.

re: What's with MCR and code 99354

you don't need the modifier 25 since the 99354 is an add on code for the extended time. no modifier is needed. you should be able to call the reopening line and ask for the modifier to be removed.

re: What's with MCR and code 99354

They've denied it (99354) both with and without the -25 modifier.
What seems more distressing is that the pattern of CMS behavior in this regard is to refuse to pay for the time given. If that's the case, why are they pushing this new scam "the medical home"; would appear as described the time for all visits would be extended to render the attention being advocated there.

Thanks for the suggestion; I'll call the re-opening line and see what happens... keep you posted.

re: What's with MCR and code 99354

Prolonged service cannot be used in "home" place of service

re: What's with MCR and code 99354

Per the CPT® procedural Coding Expert 2013, prolonged services can be used with 99350 home visit.

re: What's with MCR and code 99354

You are correct