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Prolonged physician services: Nursing facility E/M visits
Last Modified: 5/4/2024
Location: FL, PR, USVI
Business: Part A, Part B
Beginning January 1, 2023, physicians and qualified healthcare professionals (QHPs) who provide services to Medicare beneficiaries in a nursing facility or skilled nursing facility can report prolonged services for nursing facility (NF) evaluation and management (E/M) visits using Medicare-specific HCPCS code G0317. Prolonged services can be reported when time is used to select visit level, and the total practitioner time for the highest-level visit is exceeded by 15 or more minutes for medically reasonable and necessary services. List HCPCS code G0317 separately in addition to CPT codes 99306 or 99310. You should not report G0316 with other primary services. Prolonged services are not reportable in conjunction with codes for NF discharge day management.
Only physicians and QHPs who provide services to Medicare beneficiaries in a nursing facility can report these prolonged services. No other provider should bill these services.
HCPCS code G0317: Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or QHP, with or without direct patient contact.
• (List separately in addition to the CPT codes 99306 and 99310 for nursing facility care E/M visits)
• (Do not report G0317 on the same date of service as 99304, 99305, 99307, 99308, 99315 and 99316)
• (Do not report G0317 for any time unit less than 15 minutes)
Drawing on the CPT E/M Guidelines, except for critical care visits, the following listing of activities count toward total time for purposes of determining the substantive portion, when performed and whether the activities involve direct patient contact:
• Preparing to see the patient (e.g., review of tests)
• Obtaining and/or reviewing separately obtained history
• Performing a medically appropriate examination or evaluation
• Counseling and educating the patient, family or caregiver
• Ordering medications, tests, or procedures
• Referring and communicating with other health care professionals (when not separately reported)
• Documenting clinical information in the electronic or other health record
• Independently interpreting results (not separately reported) and communicating results to the patient/family/caregiver
• Care coordination (not separately reported)
Practitioners cannot count time spent on the following:
• The performance of other services that are reported separately
• Travel
• Teaching that is general and not limited to discussion that is required for the management of a specific patient
Medical review when practitioners use time to select visit level
Our reviewers will use the medical record documentation to objectively determine the medical necessity of the visit and accuracy of the documentation of the time spent (whether documented via a start and stop time or documentation of total time) if time is relied upon to support the E/M visit.
When the practitioner selects visit level using time, the practitioner may report prolonged office/outpatient E/M visit time using HCPCS add-on code G0317 (Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service). G0317 does include time one day before the visit plus date of the visit plus three days after.
The following table provides reporting examples.
Prolonged initial nursing facility E/M visit reporting
CPT/HCPC code(s) |
Total time required for reporting (*) |
Count physician/NPP time spent within this timeframe |
99306 |
45-94 minutes |
Date of visit |
99306 x 1 unit and G0317 x 1 unit |
95 minutes |
1 day before visit + date of visit + 3 days after |
Prolonged subsequent nursing facility E/M visit reporting
CPT/HCPC code(s) |
Total time required for reporting (*) |
Count physician/NPP time spent within this timeframe |
99310 |
35-84 minutes |
Date of visit |
99310 x 1 unit and G0317 x 1 unit |
85 minutes |
1 day before visit + date of visit + 3 days after |
*Total time is the sum of all time, with and without direct patient contact and including prolonged time, spent by the reporting practitioner on the date of service of the visit. Time must be used to select visit level. Prolonged service time can be reported when furnished on any date within the primary visit's surveyed timeframe. Consistent with CPT's approach, we do not assign a frequency limitation.
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