CMS Pub. 100-04, ch. 12, § 30.6.15.1

Prolonged E/M services may be reported for certain E/M visit families, when the total visit

time spent by the practitioner exceeds a certain time threshold. Prolonged E/M services are

reported using Medicare-specific coding.

See section 30.6.18 for rules regarding billing of E/M visits that are split (or shared) and

involve prolonged service time.

30.6.15.2 Prolonged Office/Outpatient E/M Visits

(Rev. 11842; Issued; 02-09-23 Effective:01-01-23; Implementation: 05-09-23)

When the practitioner selects visit level using time, the practitioner may report prolonged

office/outpatient E/M visit time using HCPCS add-on code G2212 (Prolonged office/outpatient

E/M services). The following table provides reporting examples.

HCPCS Code(s) Total Time Required for Reporting*

99205 60-74 minutes

99205 x 1 and G2212 x 1 89-103 minutes

99205 x 1 and G2212 x 2 104-118 minutes

99215 40-54 minutes

99215 x 1 and G2212 x 1 69-83 minutes

99215 x 1 and G2212 x 2 84-98 minutes

99215 x 1 and G2212 x 3 or more for each

additional 15 minutes.

99 or more

*Total time is the sum of all time, including prolonged time, spent by the reporting practitioner

on the date of service of the visit.

HCPCS code G2212 (Prolonged office or other outpatient evaluation and management

service(s) beyond the maximum required time of the primary procedure which has been

selected using total 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 99205, 99215, 99483 for office or other outpatient

evaluation and management services). (Do not report G2212 on the same date of service as

99354, 99355, 99358, 99359, 99415, 99416). (Do not report G2212 for any time unit less than

15 minutes)).

Qualifying activities are listed in the CPT Codebook’s E/M Service Guidelines (Guidelines for

Selecting Level of Service Based on Time). These activities may be counted when time is used

to select visit level, when performed and medically reasonable and necessary.

30.6.15.3 Prolonged Other E/M Visits

(Rev. 11842; Issued; 02-09-23 Effective:01-01-23; Implementation: 05-09-23)

Beginning January 1, 2023, prolonged Other E/M visit services are reported as discussed in this

section. Other E/M visits include inpatient/observation visits, nursing facility visits,

home/residence visits, and cognitive impairment assessment and care planning. Prolonged

Other E/M services may be reported with the highest visit level, for timed visits, when the total

visit time spent by the practitioner exceeds a certain time threshold.

Prolonged services are not reported in conjunction with emergency department visits or critical

care services.

Prolonged services are created to provide payment for additional practitioner time that is not

already accounted for in the valuation of the primary service. Accordingly, practitioner time

spent in qualifying activities can be counted when performed on any date within the surveyed

timeframe for the visit, and when the total time (in the physician time file) is exceeded by 15 or

more minutes. We show this in the following table.

Primary E/M Service Prolonged

Code*

Time Threshold to

Report Prolonged

Count physician/NPP time

spent within this time period

(surveyed timeframe)

Initial IP/Obs. Visit

(99223)

G0316 90 minutes Date of visit

Subsequent IP/Obs.

Visit (99233)

G0316

65 minutes Date of visit

IP/Obs. Same-Day

Admission/Discharge

(99236)

G0316 110 minutes Date of visit to 3 days after

IP/Obs. Discharge Day

Management (99238-9)

n/a n/a n/a

Emergency Department

Visits

n/a n/a n/a

Initial NF Visit (99306) G0317 95 minutes 1 day before visit + date of

visit + 3 days after

Subsequent NF Visit

(99310)

G0317 85 minutes 1 day before visit + date of

visit + 3 days after

NF Discharge Day

Management

n/a n/a n/a

Home/Residence Visit

New Pt (99345)

G0318 140 minutes 3 days before visit + date of

visit + 7 days after

Home/Residence Visit

Estab. Pt (99350)

G0318 110 minutes 3 days before visit + date of

visit + 7 days after

Cognitive Assessment

and Care Planning

(99483)

G2212 100 minutes 3 days before visit + date of

visit + 7 days after

Consults n/a n/a n/a

* Time must be used to select visit level. Prolonged service time can be reported when

furnished on any date within the primary visit’s surveyed timeframe and includes time with or

without direct patient contact by the physician or NPP. Consistent with CPT’s approach, we do

not assign a frequency limitation.

Qualifying activities are listed in the CPT Codebook’s E/M Service Guidelines (Guidelines for

Selecting Level of Service Based on Time). These activities may be counted when time is used

to select visit level, when performed and medically reasonable and necessary.