Prolonged services codes for Medicare preventive medicine services: G0513, G0514

Someone asked where to find the CMS chart with the intraservice guidelines. It is hidden deep on the CMS site! It is in the files that go with the 2018 Final Rule. Scroll down to about the 20th on the list and download 2018 List of Preventive Services Billed with Prolonged Preventive Codes.

Did you (or your clinician) ever have a wellness visit that took a really, truly, madly long time? And wondered what—if anything—you could bill with it? Wonder no more.

CMS has developed codes to be used with preventive medicine services that are time based.  These codes can be used in addition to the Welcome to Medicare visit, and initial and subsequent wellness visits.  These prolonged codes may also be used with other preventive services.  Download a complete chart of codes. I’ll discuss the other services later in the article.

Prolonged services and wellness visits

There are two new HCPCS codes that can be billed for wellness visits that are especially time consuming.

The provider must meet the threshold time for the visit, and half of the prolonged services time.

At an Open Door Forum, I asked if CMS was following the CPT^® time rule for prolonged codes, and was told that they were.  The full time of the wellness visit must be met, however, before adding the time for the prolonged code.

HCPCS codes

G0513 Prolonged preventive service(s) (beyond the typical service of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (listed separately in addition to code for preventive service)

G0514 Prolonged preventive service(s) (beyond the typical service of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (listed separately in addition to code for preventive service)

CPT^® time rule

A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed.

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