Summary & Overview
HCPCS G0514: Prolonged Preventive Service, Additional 30 Minutes
HCPCS Level II code G0514 represents additional 30-minute increments of prolonged preventive services provided in the office or other outpatient setting when direct patient contact exceeds the typical time for the primary preventive encounter. As preventive care expands to include longer counseling, coordination, and assessment activities, this code allows clinicians to document extended time devoted specifically to preventive services beyond the initial prolonged service unit.
This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise view of the code's clinical intent, typical settings of use, and the payers included in the coverage review. The publication summarizes benchmark considerations, coding relationships to the primary prolonged preventive service code G0513, and common billing modifiers and administrative notes where applicable.
The report is intended to inform coding specialists, practice managers, and policy analysts about the purpose and national relevance of G0514, the structure of prolonged preventive service reporting, and the topics to review when aligning documentation and billing workflows with payer policies. Data not available in the input are noted where specific payer rules, taxonomies, or diagnosis pairings are required for coverage determinations.
Billing Code Overview
HCPCS Level II code G0514 describes prolonged preventive service(s) delivered in the office or other outpatient setting when the service requires direct patient contact beyond the usual preventive service time. The code is reported for each additional 30 minutes of prolonged preventive service and is listed separately in addition to code G0513 for the initial prolonged service increment.
Service type: Prolonged preventive care (additional 30-minute increments)
Typical site of service: Office or other outpatient setting
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient attends a scheduled annual Medicare wellness visit in the outpatient primary care clinic. The clinician provides the standard preventive service (e.g., advance care planning, cognitive assessment, medication review, preventive counseling) but the patient requires more time than typical due to multiple chronic conditions, complex social needs, and detailed counseling about lifestyle change and immunizations. After the initial allotted prevention visit time is exhausted, the clinician documents an additional continuous 30 minutes of direct face-to-face preventive counseling and care coordination with the patient. The additional time is appended as G0514 (each additional 30 minutes) in conjunction with the primary preventive service code (for example G0513 when applicable). Typical workflow includes check-in, review of problem list and medications, focused preventive screening, extended counseling, documentation of time-based services in the medical record, and billing G0514 for each extra 30-minute increment beyond the usual preventive visit length. Typical site of service is the office or other outpatient setting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Physician or other qualified health care professional service |