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 

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.

Check out our new MaineCare logo! Learn more about this logo on the About Us page of our website.

MaineCare logo