Prolonged Preventive Service - JF Part B
Prolonged Preventive Service
Effective for claims with dates of service on or after 1/1/2018, prolonged preventive services will be payable by Medicare when billed as an add-on to an applicable preventive service that is payable from the Medicare physician fee schedule, and both deductible and coinsurance do not apply. G0513 and G0514 for prolonged preventive services was added as part of 1/1/2018, HCPCS update.
When an approved preventive service requires a prolonged period of direct-patient contact, beyond the suggested timeframe, one of the approved codes for preventive prolonged care maybe added. G0513 represents the first additional 30 minutes of time and G0514 represents each additional 30 minutes beyond the time of G0513. To meet the 30-minute expectation, you must spend at least 15 minutes of time and G0514 may not be added until the first full 30 minutes has been completed.
Timeframes for these services are as follows:
- Less than 15 minutes is not reported separately.
- G0513 x 1: 15-44 minutes
- G0513 x 1 and + G0514 x 1: 45-74 minutes (45 minutes-1 hour 14 minutes)
- G0513 x 1 and + G0514 x 2: 75-104 minutes (1 hour 15 minutes-1 hour 44 minutes)
- G0513 x 1 and + G0514 x 3: 105-134 minutes (1 hour 45 minutes-2 hours 14 minutes)
The medical record must include information to support the medical necessity of this additional time; there must be a clinically valid reason for this extra use of time in performing the preventive service. Please note the additional time may only be spent by the provider performing and billing the preventive service; these services are not subject to incident to billing. We would not expect the use of these codes to be routine or frequent in any given practice; the codes represent relatively unusual circumstances requiring the provider to spend a prolonged period of time in direct-patient contact.
Medicare coverage and frequency varies according to the individual Medicare preventive service.
Resources
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 240
- CMS Medicare Learning Network (MLN) Matters (MM) 10181 - Replacement of Mammography HCPCS Codes, Waiver of Coinsurance and Deductible for Preventive and Other Services, and Addition of Anesthesia and Prolonged Preventive Services
