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Prolonged physician services: Home or Residence Visits
Last Modified: 3/19/2024
Location: FL, PR, USVI
Business: Part A, Part B
Beginning January 1, 2023, physicians, and non-physician practitioners (NPPs) who provide services to Medicare beneficiaries in their home can report prolonged services for home or residence evaluation and management (E/M) visits using the Medicare-specific HCPCS code G0318. Prolonged home or residence E/M visits (HCPCS code G0318) should be billed instead of CPT codes 99358, 99359 or 99417. HCPCS code G0318 should be listed separately in addition to CPT codes 99345 or 99350. You should not report G0318 with other primary services.
Only physicians and NPPs who provide services to Medicare beneficiaries in the patient's home can report these prolonged services. No other provider should bill these services.
Code descriptor
HCPCS code G0318: Prolonged home or residence 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, with or without direct patient contact.
• (List separately in addition to CPT® codes 99345 or 99350)
• (Do not report G0318 on the same date of service as 99358, 99359, or 99417)
• (Do not report G0318 for any time unit less than 15 minutes)
Qualifying time
Drawing on the CPT E/M Guidelines, except for critical care visits, the following listing of activities can be counted 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 (for example, 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
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/stop time or documentation of total time) if time is relied upon to support the E/M visit.
Reporting times
When the practitioner selects visit level using time, the practitioner may report home or residence E/M visit time using HCPCS add-on code G0318 (Prolonged home or residence E/M services beyond the total time for the primary service). The following table provides reporting examples.
Prolonged Home or Residence Visit Reporting -- New Patient
CPT/HCPCS Code(s) |
Total Time Required for Reporting* |
Count physician/NPP time spent within this timeframe |
99345 |
75 -139 minutes or less |
Date of visit |
99345 x 1 and G0318 x 1 |
140 minutes |
3 days before visit + date of visit + 7 days after |
Prolonged Home or Residence Visit Reporting – Established Patient
Prolonged Home or Residence Visit Reporting -- Established Patient CPT/HCPCS Code(s) |
Total Time Required for Reporting* |
Count physician/NPP time spent within this timeframe |
99350 |
60-109 minutes or less |
Date of visit |
99350 x 1 and G0318 x 1 |
110 minutes |
3 days before visit + date of visit + 7 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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