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Preventive Services Guide
- Medicare Preventive Services Resource Guide
- Alcohol Misuse and Counseling
- Annual Wellness Visit Screening
- Bone Mass Measurements
- Cardiovascular Disease Screening Tests
- Colorectal Cancer Screening
- Counseling to Prevent Tobacco Use
- Depression Screening
- Diabetes Screening
- Diabetes Self-Management Training
- Glaucoma Screening
- Hepatitis B Virus Screening
- Hepatitis B Virus Vaccine and Administration
- Hepatitis C Virus Screening
- Human Immunodeficiency Virus Screening
- Influenza Virus Vaccine and Administration
- Initial Preventive Physical Examination
- Intensive Behavioral Therapy for Cardiovascular Disease
- Intensive Behavioral Therapy for Obesity
- Lung Cancer Screening Counseling and Annual Screening for Lung Cancer with Low-Dose Computed Tomography
- Medical Nutrition Therapy
- Pneumococcal Vaccine and Administration
- Prolonged Preventive Services
- Prostate Cancer Screening
- Screening for Cervical Cancer with Human Papillomavirus Tests
- Screening for Sexually Transmitted Infections and HIBC to Prevent STIs
- Screening Mammography
- Screening Pap Tests
- Screening Pelvic Examinations
- Ultrasound Screening for Abdominal Aortic Aneurysm
- Vaccinations
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Related Articles
- Medicare Preventive Services Resource Guide
- Medicare’s Annual Wellness Visit in Illinois: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Minnesota: Understanding the Benefit and Preventing Denials
- Medicare’s Annual Wellness Visit in Wisconsin: Understanding the Benefit and Preventing Denials
Preventive Services Guide
Prolonged Preventive Services
Effective for claims with dates of service on or after 1/1/2018, prolonged preventive services will be payable by Medicare when billed as an add-on to an applicable preventive service that is payable from the Medicare physician fee schedule, and both deductible and coinsurance do not apply. Coinsurance and deductible will be waived for the two prolonged preventive service codes, G0513 and G0514.
When an approved preventive service requires a prolonged period of direct-patient contact, beyond the suggested timeframe, you may add one of the codes for preventive prolonged care. G0513 represents the first additional 30 minutes of time and G0514 represents each additional 30 minutes beyond the time of G0513. To meet the 30-minute expectation, you must spend at least 15 minutes of time and G0514 may not be added until the first full 30 minutes has been completed.
Timeframes for these services are as follows:
- Less than 15 minutes is not reported separately.
- + G0513 x 1: 15–44 minutes
- + G0513 x 1 and + G0514 x 1: 45–74 minutes (45 minutes–1 hour 14 minutes)
- + G0513 x 1 and + G0514 x 2: 75–104 minutes (1 hour 15 minutes–1 hour 44 minutes)
- + G0513 x 1 and + G0514 x 3: 105–134 minutes (1 hour 45 minutes–2 hours 14 minutes)
You are reminded that the medical record must include information to support the medical necessity of this additional time; there must be a clinically valid reason for this extra use of time in performing the preventive service. Please note the additional time may only be spent by the provider performing and billing the preventive service; these services are not subject to incident to billing. We would not expect the use of these codes to be routine or frequent in any given practice; the codes represent relatively unusual circumstances requiring the provider to spend a prolonged period of time in direct-patient contact.
Substantive Portion
- For prolonged visits, the “substantive portion” means more than half the provider’s total time.
- We determine who performed the substantive portion based on total time.
- If more than one provider is involved, the provider who spent more than half the total time should bill for the primary E/M visit and the prolonged service codes when the service is provided as a split (or shared) visit if they meet all other split (or shared) services billing requirements. Both providers should add their time together, and whomever provided more than half the total time, including prolonged time, (the substantive portion) should report both the primary service code and the prolonged services add-on codes.
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 240
- MLN® Educational Tool: Medicare Preventive Services
Revised 10/8/2024