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HCPCS G0316 · Level II · G code

G0316: Prolong inpt eval add15 m, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G0316

Medicare payment
$34.74
PFS non-facility, national; facility $27.72
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
4
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
0 hospital outpatient
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

G0316 is a Level II code from the G section (procedures and professional services, temporary), in use since 2023: "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)". National PFS payment for G0316 is $34.74 in an office and $27.72 in a facility (October 2026), built from 0.61 work, 0.38 practice-expense and 0.05 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $34.91 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). CMS caps G0316 at practitioner 4 (MAI 3, Clinical: Data); hospital outpatient 4 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. G0316 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 3 primary codes such as 99223, 99233, 99236. G0316 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. It is on the CY2026 Medicare telehealth list (CMS action: Maintain). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS Y1 (other - Medicare fee schedule); pricing indicator 11; type of service 1 (medical care). Nearby codes: G0317, G0318, G0323, G0327.

G0316 descriptor and code status

The October 2026 HCPCS Level II file describes G0316 as “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)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0316 CPT code", G0316 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0316
FieldValue
Short descriptorProlong inpt eval add15 m
Added to HCPCS2023-01-01
Last actionN (no maintenance), effective 2023-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryY1: other - Medicare fee schedule
Type of service1: medical care

Medicare payment for G0316

National PFS payment for G0316 is $34.74 in an office and $27.72 in a facility (October 2026), built from 0.61 work, 0.38 practice-expense and 0.05 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $34.91 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period ZZZ (add-on service inside the primary service's global period); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0316
ComponentNon-facilityFacility
Work RVU0.610.61
Practice expense RVU0.380.17
Malpractice RVU0.050.05
Total RVUs1.040.83
National payment (CF $33.4009)$34.74$27.72
Qualifying APM participant (CF $33.5675)$34.91$27.86
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Medically Unlikely Edits for G0316

CMS caps G0316 at practitioner 4 (MAI 3, Clinical: Data); hospital outpatient 4 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for G0316 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services43 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital43 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for G0316 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0316 in v323r0.

G0316 is an add-on code: it is payable only with a primary service on the same claim (99223, 99233, 99236). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check G0316 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0316

No current LCD or billing and coding article lists G0316. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Telehealth status

G0316 is on the CY2026 Medicare telehealth services list (CMS action: Maintain). Bill it with the place-of-service code and modifiers that match where the patient and the practitioner are on the date of service.

Denials to expect on G0316

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of G0316 exceed the practitioner MUE of 4 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0316 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0316 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0316

What does HCPCS code G0316 describe?

"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)" (short descriptor "Prolong inpt eval add15 m"), in the G section (procedures and professional services, temporary). Added 2023-01-01.

Is G0316 a CPT code?

It is not. G0316 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT. "G0316 CPT code" searches refer to it.

What does Medicare pay for G0316?

National PFS payment for G0316 is $34.74 in an office and $27.72 in a facility (October 2026), built from 0.61 work, 0.38 practice-expense and 0.05 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $34.91 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period).

Is G0316 an add-on code?

G0316 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 3 primary codes such as 99223, 99233, 99236.

How many units of G0316 can be billed per day?

CMS caps G0316 at practitioner 4 (MAI 3, Clinical: Data); hospital outpatient 4 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 4 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0316?

G0316 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD.

Can G0316 be billed as telehealth?

Yes. G0316 is on the CY2026 Medicare telehealth list (Maintain); the place-of-service and modifier rules on the date of service still apply.

CMS guidance

The Medicare Learning Network publication that CMS issues on this topic, cited by ICN and publication date:

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.