How To Use HCPCS Code G0317

HCPCS code G0317 describes a prolonged nursing facility evaluation and management service provided by a physician or qualified healthcare professional. This code is used to report additional time spent beyond the total time for the primary service, which is selected using time on the date of the primary service. It is important to note that G0317 should not be reported on the same date of service as other prolonged services for evaluation and management, such as codes 99358, 99359, and 99418.

1. What is HCPCS G0317?

HCPCS code G0317 is used to identify a prolonged nursing facility evaluation and management service that involves additional 15-minute increments of time spent by a physician or qualified healthcare professional. This code is listed separately in addition to CPT codes 99306 and 99310, which are used for nursing facility evaluation and management services. The additional time can be spent with or without direct patient contact.

2. Official Description

The official description of HCPCS code G0317 is as follows: “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).”

The short description of G0317 is: “Prolong nursin fac eval 15m.”

3. Procedure

1. The provider begins by performing the primary nursing facility evaluation and management service using CPT codes 99306 or 99310.
2. If additional time is spent beyond the total time for the primary service, the provider can report HCPCS code G0317.
3. The additional time should be documented in 15-minute increments.
4. This additional time can be spent with or without direct patient contact.
5. Each additional 15-minute increment should be listed separately in addition to the primary service codes.

4. When to use HCPCS code G0317

HCPCS code G0317 should be used when a physician or qualified healthcare professional provides a prolonged nursing facility evaluation and management service that exceeds the total time for the primary service. It is important to note that this code should not be reported on the same date of service as other prolonged services for evaluation and management, such as codes 99358, 99359, and 99418.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0317, healthcare providers need to document the additional time spent beyond the total time for the primary service. Each additional 15-minute increment should be clearly documented. It is important to list HCPCS code G0317 separately in addition to the primary service codes (99306 or 99310).

6. Historical Information and Code Maintenance

HCPCS code G0317 was added to the Healthcare Common Procedure Coding System on January 01, 2023. As of this date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G0317 is determined by carrier judgment (coverage code C). The pricing of this code is established using national RVUs (Relative Value Units) and is not applicable under multiple pricing methodologies (pricing indicator code 11 and multiple pricing indicator code A). HCPCS code G0317 falls under the type of service code 1, which represents medical care. It is important to check with Medicare or other insurance providers regarding their specific coverage policies for this code.

8. Examples

Here are some examples of scenarios where HCPCS code G0317 should be billed:

1. A physician spends an additional 30 minutes beyond the total time for the primary nursing facility evaluation and management service. In this case, HCPCS code G0317 should be reported for two additional 15-minute increments.
2. A qualified healthcare professional spends an additional 45 minutes beyond the total time for the primary service, with 20 minutes of direct patient contact. HCPCS code G0317 should be reported for three additional 15-minute increments.
3. A physician spends an additional 15 minutes beyond the total time for the primary service, without any direct patient contact. HCPCS code G0317 should be reported for one additional 15-minute increment.
4. A qualified healthcare professional spends an additional 60 minutes beyond the total time for the primary service, with 40 minutes of direct patient contact. HCPCS code G0317 should be reported for four additional 15-minute increments.
5. A physician spends an additional 75 minutes beyond the total time for the primary service, without any direct patient contact. HCPCS code G0317 should be reported for five additional 15-minute increments.