HCPCS code G0317: Prolonged nursing facility evaluation and management service, additional 15 minutes

Learn more about how to properly use and bill for HCPCS code G0317 with our short and comprehensive guide.

## **What is HCPCS code G0317?** HCPCS code G0317 is a code with a description of: "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 qualified healthcare professional, with or without direct patient contact (list separately in addition to cpt codes 99306, 99310 for nursing facility evaluation and management services)" HCPCS G0317 is an add-on code used to report additional time spent by a physician or qualified healthcare professional providing nursing facility evaluation and management (E/M) services—beyond the time required for the primary E/M codes (CPT 99306 for initial visits or 99310 for subsequent visits). Each unit of G0317 represents an extra 15 minutes of care, with or without direct patient contact. It is only reportable when the service surpasses the highest-level E/M time threshold and must be listed separately in addition to the underlying E/M code. It cannot be used with other prolonged-service codes (e.g., 99358, 99359, 99418) or if the additional time is less than 15 minutes.

## **HCPCS code G0317 documentation requirements** To bill for G0317, the medical record must clearly and sufficiently document the following: 1. **Total time**: The total time spent by the physician or qualified healthcare professional on the date of the encounter, including both face-to-face and non-face-to-face activities. This is crucial as G0317 is a time-based add-on code. Count only physician/qualified healthcare professional time; do not include clinical staff time. 2. **Qualifying activities**: Documentation should detail the specific activities that contributed to the prolonged time. These can include: - Preparing to see the patient (e.g., reviewing tests and records). - Obtaining and reviewing patient history. - Performing a medically appropriate examination and/or evaluation. - Counseling and educating the patient, family, or caregiver. - Ordering medications, tests, or procedures. - Communicating with other healthcare professionals. - Documenting clinical information in the patient's record. - Care coordination. 3. **Medical necessity**: The documentation should support the medical necessity for the prolonged service, explaining why the patient's condition required additional time beyond the typical E/M service. 4. **Time threshold**: The time spent must exceed the maximum time for the primary E/M code by at least 15 minutes before the first unit of G0317 can be billed.

## **G0317 billing requirements** Billing G0317 has specific rules you must follow to ensure proper reimbursement: - **Add-on code**: G0317 is an add-on code and must be billed in conjunction with a primary E/M service code for a nursing facility visit, specifically 99306 (Initial Nursing Facility Care) or 99310 (Subsequent Nursing Facility Care). - **Time calculation**: The time counted for G0317 is the total time spent by the provider on the date of the primary service only, including both face-to-face and non-face-to-face activities performed on that same date. Time before or after the encounter date cannot be counted. - **Unit reporting**: G0317 is billed in 15-minute increments. You can only report a unit if the full 15 minutes has been completed. Unlike some other CPT codes, the "mid-point rule" does not apply to G0317. - **Medicare-specific**: This is a HCPCS Level II code created by the Centers for Medicare & Medicaid Services (CMS) for use when billing Medicare. Other payers may have their own guidelines or use different prolonged service codes, such as CPT code 99418. - **Exclusions**: Do not report G0317 on the same date of service as other prolonged service codes for E/M services (e.g., 99358, 99359, 99418).

## **Other relevant codes** - **G0316**: Prolonged hospital inpatient or observation care E/M services, each additional 15 minutes beyond initial or subsequent hospital E/M codes. - **G0318**: Prolonged home or residence services, each additional 15 minutes beyond home visit codes 99345 (initial) or 99350 (subsequent). - **99418**: A CPT code used for billing prolonged services for inpatient/observation or nursing facility E/M, used when primary code is selected based on time; however, CMS does not accept 99418 for Medicare reimbursement in these settings; G0317 should be used instead.

Frequently asked questions

No. For G0317, CMS requires that only the time spent on the date of the nursing facility service be counted. Time before or after the encounter date does not apply toward eligibility.

No. While 99418 is listed in CPT, CMS does not reimburse using this code in nursing facility settings; instead, HCPCS G0317 must be used for Medicare claims.

The medical record should detail how the provider spent the additional time, including face-to-face care and non-face-to-face tasks (e.g., coordinating care, counseling, ordering tests). Specific statements like “spoke with cardiology about treatment options” or “reviewed past medical records and updated care plan” enhance defensibility.