Question 1

What is HCPCS code G0318?

Accepted Answer

HCPCS code G0318 is "Prolong home eval add 15m". 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 (list separately in addition to cpt codes 99345, 99350 for home or residence evaluation and management services). (do not report g0318 on the same date of service as other prolonged services for evaluation and management 99358, 99359, 99417). (do not report g0318 for any time unit less than 15 minutes)

Question 2

What category is G0318 in?

Accepted Answer

G0318 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0318?

Accepted Answer

Use G0318 when billing for prolong home eval add 15m. 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 G0318 covered by Medicare?

Accepted Answer

Coverage for G0318 (Prolong home eval add 15m) 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 G0318?

Accepted Answer

Documentation for G0318 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).