Question 1

What is HCPCS code G0316?

Accepted Answer

HCPCS code G0316 is "Prolong inpt eval add15 m". 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 (list separately in addition to cpt codes 99223, 99233, and 99236 for hospital inpatient or observation care evaluation and management services). (do not report g0316 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99418, 99415, 99416). (do not report g0316 for any time unit less than 15 minutes)

Question 2

What category is G0316 in?

Accepted Answer

G0316 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0316?

Accepted Answer

Use G0316 when billing for prolong inpt eval add15 m. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G0316 covered by Medicare?

Accepted Answer

Coverage for G0316 (Prolong inpt eval add15 m) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G0316?

Accepted Answer

Documentation for G0316 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).