Billing Guidance for Prolonged Services
Effective January 1, 2023, MaineCare adopted additional prolonged visit codes as defined by the Centers for Medicare & Medicaid Services (CMS) and identified in the table below. NOTE: On January 1, 2021, MaineCare adopted prolonged visit code G2212 as outlined in the e-message on February 18, 2021.
Prolonged Visit Codes Covered by MaineCare |
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Code |
Description |
MaineCare Effective Date |
G2212 |
Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact. |
01/01/21 |
G0316 |
Prolonged hospital inpatient or observation care evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact |
01/01/23 |
G0317 |
Prolonged nursing facility evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact
|
01/01/23 |
G0318 |
Prolonged home or residence evaluation and management service(s) beyond the total time for the primary service (when the primary service has been selected using time on the date of the primary service); each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact |
01/01/23 |
Please contact your Provider Relations Specialist with questions regarding the use of prolonged visit codes.
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