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HCPCS G0513 · Level II · G code

G0513: Prolonged preventive service(s) (beyond the typical service time of the primary procedure), 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 G0513

Medicare payment
$64.80
PFS non-facility, national; facility $50.77
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

HCPCS Level II G0513 reads "Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)" in the October 2026 file; it dates from 2018. Medicare's October 2026 physician fee schedule pays G0513 $64.80 non-facility and $50.77 facility nationally, from 1.17 work, 0.70 practice-expense and 0.07 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $65.12 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). MUE limits for G0513: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). G0513 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 17 primary codes such as 76706, 76977, 77063, 77067. No current LCD or billing article lists G0513; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). 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 M5D (specialist - other); pricing indicator 13; type of service 1 (medical care). 1 other active code opens with "Prolonged preventive service"; related codes: G0514, G0516, G0508, G0506.

G0513 descriptor and code status

The October 2026 HCPCS Level II file describes G0513 as “Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0513 CPT code", G0513 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 G0513
FieldValue
Short descriptorProlong prev svcs, first 30m
Added to HCPCS2018-01-01
Last actionN (no maintenance), effective 2018-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryM5D: specialist - other
Type of service1: medical care

Medicare payment for G0513

Medicare's October 2026 physician fee schedule pays G0513 $64.80 non-facility and $50.77 facility nationally, from 1.17 work, 0.70 practice-expense and 0.07 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $65.12 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 G0513
ComponentNon-facilityFacility
Work RVU1.171.17
Practice expense RVU0.700.28
Malpractice RVU0.070.07
Total RVUs1.941.52
National payment (CF $33.4009)$64.80$50.77
Qualifying APM participant (CF $33.5675)$65.12$51.02
  • 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 G0513

MUE limits for G0513: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0513 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for G0513 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0513 in v323r0.

G0513 is an add-on code: it is payable only with a primary service on the same claim (76706, 76977, 77063, 77067, 77078, 77080, 77081, G0101, G0104, G0105, G0121, G0130, and others). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check G0513 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0513

No current LCD or billing and coding article lists G0513. 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

G0513 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 G0513

CARC 50 · N115

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

CARC 151 · N362

units of G0513 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for G0513 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0513 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 G0513

What does HCPCS code G0513 describe?

"Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)" (short descriptor "Prolong prev svcs, first 30m"), in the G section (procedures and professional services, temporary). Added 2018-01-01.

Is G0513 a CPT code?

No: CMS maintains G0513 in HCPCS Level II, while the AMA maintains CPT. People do search "G0513 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for G0513?

Medicare's October 2026 physician fee schedule pays G0513 $64.80 non-facility and $50.77 facility nationally, from 1.17 work, 0.70 practice-expense and 0.07 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $65.12 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period).

Is G0513 an add-on code?

G0513 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 17 primary codes such as 76706, 76977, 77063, 77067.

How many units of G0513 can be billed per day?

MUE limits for G0513: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0513?

No current LCD or billing article lists G0513; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

Can G0513 be billed as telehealth?

Yes. G0513 is on the CY2026 Medicare telehealth list (Maintain); the place-of-service and modifier rules on the date of service still apply.

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.