Summary & Overview

HCPCS G0317: Prolonged Nursing Facility Evaluation and Management Service

HCPCS Level II code G0317 designates each additional 15 minutes of prolonged evaluation and management (E/M) care in a nursing facility performed by a physician or qualified healthcare professional, beyond the time allotted for the primary nursing facility E/M visit. It is used only when the primary service on the same date is selected by time (not by other visit codes) and pairs with nursing facility E/M codes such as 99306 and 99310. The code clarifies billing for extended time spent on complex or time-intensive management of nursing facility residents.

This national overview covers common payer handling for Medicare and major national commercial plans: Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find a concise explanation of the clinical and billing context for prolonged nursing facility E/M services, common modifiers and billing relationships to primary nursing facility E/M codes, and guidance on typical site-of-service use. The publication summarizes where G0317 fits in the E/M documentation workflow, potential billing conflicts (for example, simultaneous reporting with other prolonged E/M codes), and what to expect from payers in terms of coverage policy language.

Intended for clinicians, coding specialists, and policy analysts, the article provides a clear reference for when G0317 should be considered, how it relates to time-based primary nursing facility visits, and which payers are most commonly referenced in national policy guidance.

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Billing Code Overview

HCPCS Level II code G0317 describes a prolonged nursing facility evaluation and management service provided beyond the total time assigned to the primary nursing facility E/M service. The code is reported for each additional 15 minutes of physician or qualified healthcare professional time, with or without direct patient contact, when the primary service is selected by time on the date of the primary service. The code is intended for use in the nursing facility setting and applies to prolonged evaluation and management services associated with nursing facility E/M codes 99306 and 99310.

Service type: Prolonged nursing facility evaluation and management service

Typical site of service: Nursing facility (long-term care, skilled nursing facility)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A nursing facility resident with multiple chronic conditions (for example, I50.9 congestive heart failure, E11.9 type 2 diabetes mellitus without complications, and N18.4 chronic kidney disease, stage 4) is seen by a physician or qualified healthcare professional for a comprehensive evaluation and management (E/M) visit billed as a primary nursing facility E/M code (for example, 99306 or 99310) based on time. The primary encounter extends beyond the typical time due to complex medication reconciliation, coordination with family and facility staff, review of recent hospital records, and formulation of an expanded plan of care. After the primary timed E/M service is reported, additional face-to-face or non–face-to-face time increments of 15 minutes are captured using the prolonged nursing facility service code G0317 to reflect extra clinician work.

Typical clinical workflow:

Facility nurse notifies the physician of clinical deterioration or a scheduled comprehensive visit.
The clinician reviews the medical record, hospital discharge summaries, medication lists, and recent laboratory results prior to or during the visit.
The clinician performs the primary nursing facility E/M service (e.g., 99306 or 99310) using time as the controlling or typical selection basis.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service	Use when a distinct E/M visit is provided on the same day as another service in addition to the prolonged service documentation for the nursing facility visit
`52`	Reduced services	Use when the nursing facility service or prolonged time is partially reduced or not fully performed
`53`	Discontinued procedure	Use when the E/M visit or prolonged service is discontinued due to extenuating circumstances
`62`	Two surgeons	Rare for E/M but used when two practitioners of different specialties share responsibility for the visit in applicable scenarios
`78`	Return to operating room for related procedure during postoperative period	Not typical for `G0317`; use only when clinically appropriate and allowed by payer rules
`80`	Assistant surgeon present	Use only when an assistant surgeon is billing in conjunction with an encounter that appropriately documents surgical involvement
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when the prolonged nursing facility E/M time is performed via approved real-time telemedicine and payer allows `G0317` for telemedicine
`GT`	Via interactive audio and video telecommunications systems	Use when payer requires `GT` for telemedicine services associated with the E/M visit
`GQ`	Via asynchronous telecommunications system	Use when applicable by payer policy for non–real-time telecommunication services contributing to the prolonged time
`GA`	Waiver of liability statement on file (Note: `GA` not in provided list; excluded)	Data not applicable

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Common primary clinician providing nursing facility E/M visits
`207R00000X`	Internal Medicine	Frequently manages complex chronic conditions in nursing facility residents
`2080P0122X`	Geriatric Medicine	Specialists in care of older adults in nursing facilities
`1835S0001X`	Nurse Practitioner	Advanced practice clinician providing E/M and prolonged services in nursing facilities
`363LF0000X`	Physician Assistant	Commonly provides or assists with nursing facility evaluations and may bill under supervising physician or PA taxonomy

ICD-10 Code	Description	Clinical Relevance
`I50.9`	Heart failure, unspecified	Common chronic condition in nursing facility residents prompting extended evaluation and care planning
`E11.9`	Type 2 diabetes mellitus without complications	Chronic disease requiring medication review and coordination during prolonged visits
`N18.4`	Chronic kidney disease, stage 4 (severe)	Complex comorbidity that increases time for management decisions and coordination
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Respiratory disease that may necessitate extended assessment and care adjustments
`F03.90`	Unspecified dementia without behavioral disturbance	Cognitive impairment requiring additional time for history gathering and caregiver communication

CPT Code	Description	Relationship to This Procedure
`99306`	Nursing facility visit, established patient, comprehensive assessment; typically 45 minutes	Primary timed E/M service for which additional time beyond the service may be reported with `G0317` for each extra 15-minute increment
`99310`	Nursing facility visit, new or established patient, comprehensive assessment; typically 70 minutes	Primary prolonged nursing facility E/M service; `G0317` is appended for each additional 15 minutes beyond the primary service time
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	May be performed during the nursing facility encounter but billed separately if payer rules permit
`99408`	Alcohol and/or substance abuse structured screening and brief intervention services, 15–30 minutes	May occur during the prolonged encounter and could be billed separately per payer policy
`99307`	Nursing facility visit, established patient, problem focused	Lower-level nursing facility E/M that may precede escalation to a comprehensive timed visit requiring `G0317` if additional time is needed

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