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    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0317-prolonged-nursing-facility-evaluation-em-service
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    HCPCS G0317: Prolonged Nursing Facility Evaluation and Management

    Medicare pays $35 on average nationally for this procedure.

    HCPCS Level II code G0317 describes prolonged nursing facility evaluation and management services provided by a physician or qualified healthcare professional in a nursing facility when total time for the primary E/M service has been exceeded; it is reported for each additional 15 minutes beyond the primary nursing facility E/M service time and is an add-on to time-based nursing facility codes such as 99306 and 99310, with the requirement that units be at least 15 minutes and not reported on the same date as other prolonged E/M service codes 99358, 99359, or 99418.

    For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease.

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    Table of contents

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    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.

    • When the total time spent on the date of service exceeds the primary service time threshold, the clinician documents additional fifteen-minute increments of prolonged service.

    • Each additional 15 minutes beyond the primary service time is reported with G0317, documented with start/stop times or cumulative time, and linked to the primary E/M service. G0317 is not reported on the same date as other non–nursing-facility prolonged service codes such as 99358, 99359, or 99418.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99306Nursing facility visit, established patient, comprehensive assessment; typically 45 minutesPrimary timed E/M service for which additional time beyond the service may be reported with G0317 for each extra 15-minute increment
    99310Nursing facility visit, new or established patient, comprehensive assessment; typically 70 minutesPrimary prolonged nursing facility E/M service; G0317 is appended for each additional 15 minutes beyond the primary service time
    99406Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutesMay be performed during the nursing facility encounter but billed separately if payer rules permit
    99408

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    363LF0000XFamily Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    3416A0800XAir AmbulanceTransportation Services · Ambulance
    213EP0504XPublic Medicine PodiatristPodiatric Medicine & Surgery Service Providers · Podiatrist
    163WD1100XPeritoneal Dialysis Registered NurseNursing Service Providers · Registered Nurse
    207RG0300XGeriatric Medicine (Internal Medicine) PhysicianAn internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects o…
    374T00000XReligious Nonmedical Nursing PersonnelReligious nonmedical nursing personnel are experienced in caring for the physical needs of nonmedical patients. For example, caring for the physical …

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    A41.9Sepsis, unspecified organism
    B95.61Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere
    E11.9Type 2 diabetes mellitus without complications
    E78.5Hyperlipidemia, unspecified
    F03.90Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    F32.9Major depressive disorder, single episode, unspecified
    I21.9Acute myocardial infarction, unspecified
    I50.9Heart failure, unspecified
    I63.9Cerebral infarction, unspecified
    J18.9Pneumonia, unspecified organism

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01
    Celiac Disease TestingOscar Health2026-10-01
    Laboratory Testing for the Diagnosis of Inflammatory Bowel DiseaseOscar Health2026-10-01
    Percutaneous Electrical Nerve Field Stimulation (PENFS)Cigna2026-09-15
    Colorectal Cancer ScreeningBlue Cross Blue Shield - New Mexico2026-09-04

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

    HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

    HCPCS G0008: Administration of Influenza Virus Vaccine

    HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

    HCPCS G0009: Administration of Pneumococcal Vaccine

    HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

    HCPCS G0010: Administration of Hepatitis B Vaccine

    HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

    HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

    HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

    HCPCS G0012: Injection of PrEP Drug for HIV Prevention

    HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

    HCPCS G0013: Individual PrEP Counseling by Clinical Staff

    HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

    HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

    HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

    HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

    HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

    HCPCS G0019: Community Health Integration, Person-Centered Assessment

    Showing 1–10 of 1996

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    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
    99307Nursing facility visit, established patient, problem focusedLower-level nursing facility E/M that may precede escalation to a comprehensive timed visit requiring G0317 if additional time is needed