Skip to main content
HCPCS G0318 · Level II · G code

G0318: Prolong home eval add 15m, 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 G0318

Medicare payment
$34.07
PFS non-facility, national; facility $27.39
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
4
MAI 3
OPPS status
SI B
Non-allowed item or service for OPPS
NCCI PTP pairs
0
0 hospital outpatient
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

CMS describes HCPCS G0318, added in 2023, as "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)". Medicare's October 2026 physician fee schedule pays G0318 $34.07 non-facility and $27.39 facility nationally, from 0.61 work, 0.36 practice-expense and 0.05 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $34.24 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). MUE limits for G0318: practitioner 4 (MAI 3, Clinical: Data); hospital outpatient 4 (MAI 3, Clinical: Data). G0318 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 2 primary codes such as 99345, 99350. G0318 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 B: Non-allowed item or service for OPPS. HCPCS record: BETOS Y1 (other - Medicare fee schedule); pricing indicator 11; type of service 1 (medical care). Nearby codes: G0317, G0316, G0323, G0327.

G0318 descriptor and code status

The October 2026 HCPCS Level II file describes G0318 as “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)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0318 CPT code", G0318 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 G0318
FieldValue
Short descriptorProlong home eval add 15m
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 G0318

Medicare's October 2026 physician fee schedule pays G0318 $34.07 non-facility and $27.39 facility nationally, from 0.61 work, 0.36 practice-expense and 0.05 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $34.24 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 G0318
ComponentNon-facilityFacility
Work RVU0.610.61
Practice expense RVU0.360.16
Malpractice RVU0.050.05
Total RVUs1.020.82
National payment (CF $33.4009)$34.07$27.39
Qualifying APM participant (CF $33.5675)$34.24$27.53
  • 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 B (Non-allowed item or service for OPPS), with no separate OPPS payment rate.

Medically Unlikely Edits for G0318

MUE limits for G0318: practitioner 4 (MAI 3, Clinical: Data); hospital outpatient 4 (MAI 3, Clinical: Data). 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 G0318 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 G0318 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0318 in v323r0.

G0318 is an add-on code: it is payable only with a primary service on the same claim (99345, 99350). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check G0318 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0318

No current LCD or billing and coding article lists G0318. 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

G0318 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 G0318

CARC 50 · N115

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

CARC 151 · N362

units of G0318 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 G0318 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0318 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 G0318

What does HCPCS code G0318 describe?

"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)" (short descriptor "Prolong home eval add 15m"), in the G section (procedures and professional services, temporary). Added 2023-01-01.

Is G0318 a CPT code?

No: CMS maintains G0318 in HCPCS Level II, while the AMA maintains CPT. People do search "G0318 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for G0318?

Medicare's October 2026 physician fee schedule pays G0318 $34.07 non-facility and $27.39 facility nationally, from 0.61 work, 0.36 practice-expense and 0.05 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $34.24 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period).

Is G0318 an add-on code?

G0318 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 2 primary codes such as 99345, 99350.

How many units of G0318 can be billed per day?

MUE limits for G0318: practitioner 4 (MAI 3, Clinical: Data); hospital outpatient 4 (MAI 3, Clinical: Data). 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 G0318?

G0318 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 G0318 be billed as telehealth?

Yes. G0318 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.