How To Use HCPCS Code G0514

HCPCS code G0514 describes a prolonged preventive service that goes beyond the typical service time of the primary procedure. This code is used to identify additional 30 minutes of preventive service provided in the office or other outpatient setting, requiring direct patient contact beyond the usual service. It is important for medical coders to understand the meaning and usage of this code to ensure accurate billing and reimbursement.

1. What is HCPCS G0514?

HCPCS code G0514 is a specific code used to identify prolonged preventive service(s) that exceed the typical service time of the primary procedure. It is used when an additional 30 minutes of preventive service is provided in the office or other outpatient setting, requiring direct patient contact beyond the usual service. This code should be listed separately in addition to code G0513 for each additional 30 minutes of preventive service.

2. Official Description

The official description of HCPCS code G0514 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; each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service).” The short description for this code is “Prolong prev svcs, addl 30m.”

3. Procedure

1. Before using HCPCS code G0514, the healthcare provider must first perform the primary preventive service procedure.
2. If the provider determines that additional time is necessary to complete the preventive service, beyond the typical service time, they can use code G0514 to identify each additional 30 minutes of service.
3. The provider should document the specific activities and interventions performed during the prolonged preventive service, as well as the duration of the additional time spent with the patient.
4. The use of code G0514 should be supported by the medical record documentation to ensure accurate billing and reimbursement.

4. When to use HCPCS code G0514

HCPCS code G0514 should be used when the healthcare provider performs a preventive service that requires additional time beyond the typical service time of the primary procedure. This code is used to identify each additional 30 minutes of preventive service provided in the office or other outpatient setting, where direct patient contact is required beyond the usual service.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0514, healthcare providers need to ensure that the medical record documentation supports the use of this code. The documentation should clearly indicate the need for additional time beyond the typical service time of the primary procedure and describe the specific activities and interventions performed during the prolonged preventive service.

6. Historical Information and Code Maintenance

HCPCS code G0514 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. It is important for medical coders to stay updated on any changes or revisions to the code in the future.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code G0514 may vary depending on the carrier and insurance policies. The pricing indicator code for this code is 13, which means the price is established by carriers. The multiple pricing indicator code is A, indicating that it is not applicable as HCPCS priced under one methodology. It is recommended to check with the specific insurance carrier or Medicare for their coverage policies and reimbursement rates for this code.

8. Examples

Here are five examples of scenarios where HCPCS code G0514 should be billed:

1. A primary preventive service is performed, and the provider determines that an additional 30 minutes of preventive service is necessary to address the patient’s specific needs.
2. A patient requires an extended counseling session as part of their preventive care, which exceeds the typical service time of the primary procedure by 30 minutes.
3. A provider performs a comprehensive preventive examination and spends an additional 30 minutes discussing and addressing the patient’s concerns and questions.
4. A patient with complex medical conditions requires an extended preventive service, involving additional time for assessment, education, and coordination of care.
5. A provider performs a preventive service that involves multiple interventions and requires additional time to complete, exceeding the typical service time by 30 minutes.