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Prolonged physician services: Nursing facility E/M visits
Last Modified: 1/3/2025
Location: FL, PR, USVI
Business: Part A, Part B
Prolonged services were created to provide payment for additional practitioner time that is not already accounted for in the valuation of the primary service. CMS developed specific Medicare guidance for prolonged services which differs from the American Medical Association (AMA). The prolonged service codes in CPT are not valid for Medicare billing purposes. Medicare Administrative Contractors (MACs) will process claims for prolonged services per the
CMS IOM Pub. 100-04, Chapter 12, Section 30.6 - E/M Service Codes .
Prolonged services may be reported when time is used to select the visit level. Accordingly, the practitioner's time spent performing qualifying activities may be counted when performed on any date within the surveyed timeframe for the visit, and when the total time (in the physician time file) for the highest-level nursing facility visit is exceeded by 15 or more minutes for reasonable and medically necessary services.
Only physicians and non-physician practitioners who provide services to Medicare beneficiaries in the nursing facility can report prolonged services. Prolonged services are not reportable in conjunction with codes for nursing facility discharge day management.
Prolonged nursing facility services are reported using Medicare-specific coding, HCPCS G0317.
HCPCS G0317 is defined as a p
rolonged 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 qualified healthcare professional (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.
The following listing of activities can be counted toward total time for purposes of determining the substantive portion, when performed and whether or not 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 and/or evaluation
• Counseling and educating the patient/family/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
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 (whether documented via a start/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 nursing facility 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 includes time spent one day before the visit, the date of the visit, and three days after.
The following table provides the total time requirements established by CMS to report the initial unit of prolonged services.
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99306 (initial nursing facility care, 50 minutes) |
G0317 x 1 unit |
95 minutes |
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99310 (subsequent nursing facility care, 45 minutes) |
G0317 x 1 unit |
85 minutes |
The total time is the sum of all time. This includes time spent with and without direct patient contact, including prolonged time spent by the reporting practitioner. When billing prolonged services, time must be used to select the visit level. Prolonged service time includes time spent on qualified activities furnished on any date within the primary visit’s surveyed timeframe - for nursing facility visits, this includes the day before, the day of and three days after the primary visit date of service. Consistent with CPT’s approach, we do not assign a frequency limitation regarding the number of visits.
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