How To Use HCPCS Code G0513

HCPCS code G0513 describes a prolonged preventive service in the office or other outpatient setting that requires direct patient contact beyond the usual service time of the primary procedure. This code is used to report the first 30 minutes of extended preventive services provided by healthcare providers.

1. What is HCPCS G0513?

HCPCS code G0513 is used to identify and report prolonged preventive services that go beyond the typical service time of the primary procedure. These services involve direct patient contact and are provided in the office or other outpatient setting. The code specifically represents the first 30 minutes of extended preventive services.

2. Official Description

The official description of HCPCS code G0513 is “Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service).” The short description is “Prolong prev svcs, first 30m.”

3. Procedure

1. When providing prolonged preventive services, the healthcare provider should ensure that the service time exceeds the typical duration of the primary preventive procedure.
2. The services should involve direct patient contact, which may include counseling, education, or other interventions aimed at preventing illness or promoting health.
3. The services are typically provided in the office or other outpatient setting.
4. The first 30 minutes of extended preventive services should be reported using HCPCS code G0513 in addition to the code for the primary preventive service.

4. When to use HCPCS code G0513

HCPCS code G0513 should be used when healthcare providers provide prolonged preventive services that require direct patient contact beyond the usual service time of the primary procedure. These services are typically provided in the office or other outpatient setting. It is important to note that this code should only be used for the first 30 minutes of extended preventive services.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0513, healthcare providers need to ensure that the services provided meet the criteria for prolonged preventive services. The documentation should clearly indicate the extended duration of the preventive services and the direct patient contact involved. It is also important to include the code for the primary preventive service in addition to HCPCS code G0513.

6. Historical Information and Code Maintenance

HCPCS code G0513 was added to the Healthcare Common Procedure Coding System on January 01, 2018. As of the effective 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 and pricing of HCPCS code G0513 may vary depending on the carrier and insurance policies. The pricing indicator code 13 indicates that the price for this code is established by carriers, meaning it is not otherwise classified and is subject to individual determination or carrier discretion. The multiple pricing indicator code A indicates that the code is not applicable as HCPCS priced under one methodology. It is important to check with Medicare or other insurers to determine the coverage and reimbursement policies for this code.

8. Examples

Here are five examples of scenarios where HCPCS code G0513 should be billed:

1. A primary care physician provides a preventive visit to a patient and spends an additional 30 minutes counseling the patient on lifestyle modifications to prevent chronic diseases.
2. A gynecologist performs a routine preventive examination on a patient and spends an additional 30 minutes discussing contraceptive options and providing education on sexually transmitted infections.
3. A pediatrician conducts a well-child visit for a toddler and spends an additional 30 minutes addressing parental concerns and providing guidance on age-appropriate nutrition and development.
4. A cardiologist performs a preventive cardiovascular risk assessment on a patient and spends an additional 30 minutes discussing the results, lifestyle modifications, and medication management.
5. An endocrinologist provides a preventive visit to a patient with diabetes and spends an additional 30 minutes reviewing blood glucose logs, adjusting medication dosages, and providing diabetes self-management education.