HCPCS code G0318: Prolonged Home or Residence Evaluation and Management Services (each additional 15 minutes)

Learn more about HCPCS code G0318, its documentation, and billing requirements, for proper use and billing.

## **What is HCPCS code G0318?** HCPCS code G0318 has a code description of: "Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service, each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact." It applies when a physician or qualified healthcare professional performs an evaluation and management (E/M) service in a home or residential setting, and the total time exceeds that required for the highest-level E/M code (CPT 99345 or 99350) by at least 15 minutes. It is an add-on code, billed in 15-minute increments, and can include both face-to-face and non-face-to-face time. This code is specifically for Medicare and Medicaid services billing to report prolonged services under the Medicare system.

## **HCPCS code G0318 documentation requirements** For a provider to bill G0318, the medical record must clearly and objectively document the following: - Total time spent: The documentation must show the total time spent on the date of the primary E/M service, including all activities before, during, and after the direct patient contact. This can be documented with start and stop times or a single, total time. - Medical necessity: The prolonged home or residence services must be medically reasonable and necessary for the patient's condition. - Time-based selection: The primary E/M service code (e.g., CPT codes 99345 or 99350) must have been selected based on time, not on medical decision-making (MDM). - Qualifying activities: The prolonged time must include activities that are not separately billable, such as: 1. Reviewing test results 2. Obtaining and/or reviewing a patient's separately obtained history 3. Counseling and educating the patient or their family 4. Ordering medications, tests, or procedures 5. Documenting clinical information in the patient's record 6. Care coordination with other healthcare professionals

## **G0318 billing requirements** To prevent denial of claims for HCPCS codes - Primary codes: G0318 must be billed with the highest-level home or residence E/M codes, which are 99345 (new patient) or 99350 (established patient). - Time thresholds: The primary E/M service code must first meet its total time requirement before any prolonged time can be counted. For example, for a new patient, the total time must exceed 140 minutes to bill for the first unit of G0318. For an established patient, the total time must exceed 110 minutes. - Unit of time: Each unit of G0318 represents an additional 15 minutes of service on the date of the encounter. The full 15 minutes must be completed to bill one unit. There is no "midpoint rule" for this code. - Do not report with other codes: You cannot bill G0318 on the same date of service as other prolonged service codes for E/M (e.g., CPT codes 99358, 99359, or 99417) as they are considered mutually exclusive.

## **Other relevant codes** - **99345**: Home or residence E/M services, new patient, high level MDM or at least 75 minutes total time - **99350**: Home or residence services, established patient , high level MDM or at least 60 minutes total time - **G0316**: Prolonged hospital inpatient or observation care evaluation and care service (each additional 15 minutes) - **G0317**: Prolonged nursing facility evaluation and management service (each additional 15 minutes) - **G2212**: Prolonged office or other outpatient E/M service (each additional 15 minutes)

Frequently asked questions

No. G0318 is specifically for prolonged E/M services provided in a patient's home or residence and is used exclusively for Medicare beneficiaries. For other settings, different prolonged service codes apply.

No. Travel time is not considered a qualifying activity and cannot be counted toward the total time for billing G0318.

No. The prolonged time can include both time with and without direct patient contact, as long as it's personally furnished by the billing provider on the date of the service and is medically necessary.