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Hint: Time spent on services the day before and after the visit may count.

Sometimes seeing a patient in the nursing facility can take more time than intended 鈥� or even more time than the nursing facility CPT^庐 codes allow. In these cases, you may have the option of reporting prolonged services codes to Medicare.

The add-on code that the Centers for Medicare & Medicaid Services (CMS) accepts with the nursing facility evaluation and management (E/M) codes debuted in 2023, but it still isn鈥檛 well-understood. Check this primer to pinpoint when you can report prolonged services in the nursing facility and when you can鈥檛.

Set Your Sights on G0317

When your provider performs a prolonged nursing facility (NF) service, you鈥檒l use the add-on code G0317 (Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service 鈥�; each additional 15 minutes 鈥� (do not report G0317 for any time unit less than 15 minutes)) along with one of the below NF codes:

• 99306 (Initial nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 50 minutes must be met or exceeded.)
• 99310 (Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.)

Here鈥檚 the difference: These codes are both reported on a per-day basis for your provider鈥檚 care of the NF patient. The difference between the two codes is that 99306 applies to initial visits to the NF, while 99310 is reported for subsequent NF visits.

The Visit Must Exceed the Highest-Level E/M by 15 Minutes

If you鈥檙e aiming to bring in extra reimbursement for prolonged nursing facility services, you鈥檒l need to hit a certain time threshold first.

鈥淏eginning January 1, 2023, prolonged NF services are reported using Medicare-specific coding (HCPCS code G0317),鈥� CMS says in Chapter 12 of the . 鈥淧rolonged services can be reported when time is used to select visit level, and the total time for the highest-level visit is exceeded by 15 or more minutes for services that are reasonable and necessary.鈥�

Non-Face-to-Face Activities May Count Toward Time Threshold

If you鈥檙e trying to get to the time threshold to report G0317, keep in mind that you can only use the activities that the provider documents in the medical record. But your review isn鈥檛 limited to just the time the provider spends with the patient. You can also count additional activities toward the time, says in a fact sheet published on January 3, 2025. Consider all of the following activities among those that you can count toward total time:

• Reviewing the patient鈥檚 record, previous tests, or other documentation during visit preparation
• Ordering tests, procedures, or medications for the patient
• Getting a separately obtained history from another provider and reviewing it
• Examining the patient or performing other tests
• Educating or counseling the patient and/or their caregivers
• Communicating with other healthcare professionals and referring the patient to other providers
• Adding documentation to the clinical record
• Interpreting results and sharing them with the patient and/or their caregivers
• Coordinating the patient鈥檚 care

You鈥檒l include services relating to the patient鈥檚 visit that you perform one day before the visit, the day of the visit, and three days after the visit. This means if you see the patient on Tuesday, you can count activities you perform on Monday, Tuesday, Wednesday, Thursday, and Friday of that week toward the total time you tally for the date of service, CMS says in Chapter 12.

Check This Chart for Clarity

Once you tally the time the doctor spends with the patient and the time spent performing other patient-related activities that week, you鈥檒l add all of those times together. 鈥淭otal time is the sum of all time, with and without direct patient contact, including prolonged time, spent by reporting practitioner on the encounter date of service,鈥� says in a fact sheet.

If your provider sees a patient in the nursing facility and you鈥檙e not quite sure whether you can report a prolonged service code, consult this chart.

Your documentation should include start and end times OR total time of the visit, along with the date of service, according to Noridian.

Check Out This Example

Dr. Smith has an initial visit scheduled with Mary Jones at the nursing facility on March 18. The medical record includes documentation of the following:

• March 17: 10 minutes reviewing the patient鈥檚 records from her previous physician
• March 17: 15 minutes going over the patient鈥檚 laboratory results and X-ray interpretations, which came in that morning
• March 18: 20 minutes performing a physical exam of the patient
• March 18: 20 minutes sharing the care plan with the patient and her daughter
• March 18: 15 minutes answering questions from the patient and her daughter
• March 18: 5 minutes ordering medications and follow-up testing for the patient
• March 19: 5 minutes calling the patient鈥檚 cardiologist to discuss the treatment plan moving forward
• March 19: 5 minutes speaking with the patient鈥檚 endocrinologist to discuss how her worsening glucose numbers will be managed in light of her new prescriptions.

The total time of 95 minutes warrants the prolonged service code in this situation. Therefore, on the patient鈥檚 claim, you鈥檇 report:

• 1 unit of 99306
• 1 unit of G0317.

Torrey Kim, Contributing Writer, Raleigh, North Carolina