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    v1.0.28
    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0514-prolonged-preventive-service-additional-30-minutes
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    HCPCS G0514: Prolonged Preventive Service, Additional 30 Minutes

    Medicare pays $67 on average nationally for this procedure.

    HCPCS Level II code G0514 describes an additional 30 minutes of prolonged preventive service provided in the office or other outpatient setting when direct patient contact extends beyond the typical time of the primary preventive service; it is intended to be reported in addition to the primary prolonged preventive service code and documents extended counseling or care time for preventive counseling, risk assessment, or health behavior interventions in outpatient preventive visits.

    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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    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99381Initial comprehensive preventive medicine evaluation and management of an individual — new patient; infant (new)May precede or be the primary preventive service when prolonged time is required for a new patient visit; G0514 would be billed only in conjunction with the appropriate HCPCS preventive code where allowed.
    99391Periodic comprehensive preventive medicine re-evaluation and management of an individual — established patient; infant (established)Routine preventive visits for established patients; prolonged preventive time beyond the usual visit can require an additional time-based code such as G0514 where applicable.
    99406Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutesShort behavior-change counseling that may occur within the preventive visit; extended counseling beyond typical time can trigger prolonged service billing.
    99407Smoking and tobacco use cessation counseling, intensive, greater than 10 minutesRepresents more intensive counseling often part of extended preventive services requiring additional time.
    99497Advance care planning including the explanation and discussion of advance directives, first 30 minutesAdvance care planning is commonly provided during preventive visits; if additional 30-minute increments beyond typical preventive service are required, G0514 may be reported in conjunction per payer rules.
    G0438Annual wellness visit, initial visit, includes a personalized prevention plan of service (PPPS)The annual wellness visit is a common primary preventive service; prolonged preventive services beyond the standard AWV time are billed with add-on codes like G0514 per applicable insurer policies.

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    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…
    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
    207P00000XEmergency Medicine PhysicianAn emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospit…
    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…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    163WA2000XAdministrator Registered NurseNursing Service Providers · Registered Nurse
    133VN1501XSports Dietetics Nutrition Registered DietitianAn individual who is a Board Certified Specialist in Sports Dietetics and applies evidence-based nutrition knowledge in exercise and sports. RDNs spec…
    2084P0015XPsychosomatic Medicine PhysicianPsychosomatic Medicine is subspecialty in the diagnosis and treatment of psychiatric disorders and symptoms in complex medically ill patients. This su…
    364SC1501XCommunity Health/Public Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    2084E0001XEpilepsy PhysicianEpilepsy is a subspecialty of neurology focused on the diagnosis and treatment of patients with epilepsy, including new-onset, medically refractory ep…

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    E11.9Type 2 diabetes mellitus without complications
    E78.5Hyperlipidemia, unspecified
    F33.1Major depressive disorder, recurrent, moderate
    F41.1Generalized anxiety disorder
    I10Essential (primary) hypertension
    R53.1Weakness
    R73.9Hyperglycemia, unspecified
    Z00.00Encounter for general adult medical examination without abnormal findings
    Z00.01Encounter for general adult medical examination with abnormal findings
    Z00.121Encounter for routine child health examination with abnormal findings

    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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