HCPCS Code G0514: Medicare Billing Explained

G0514 is an HCPCS Level II add-on code for billing Medicare for each additional 30 minutes of prolonged preventive services beyond the first 30 minutes captured by G0513. 

G0514 applies only to Medicare-covered preventive visits that run significantly longer than their typical service time, and it always requires G0513 on the same claim.

Most billing teams either skip this code or misuse it, resulting in lost revenue on complex wellness visits or denied claims from improper documentation.

This guide covers every rule, threshold, and scenario you need to bill HCPCS Code G0514 correctly.

Why Was G0514 Created and Who Should Use It?

Centers for Medicare & Medicaid Services (CMS) introduced G0514 alongside G0513 on January 1, 2018, through the Medicare Physician Fee Schedule final rule. Before these codes existed, providers had no way to capture extra time spent on Medicare-covered preventive services.

The codes target visits where patient complexity (multiple chronic conditions, cognitive decline, language barriers) pushes a preventive service well beyond its typical duration. 

Primary care physicians, family medicine providers, internists, geriatricians, and OB-GYNs are the most common users of G0514, but any provider type eligible to bill Medicare preventive services can use these codes when time thresholds are met.

How G0514 Works in Billing Workflow

Think of the billing structure as a sequence:

• Base preventive service (e.g., AWV)
• G0513 → first 30 minutes of prolonged time
• G0514 → each additional 30-minute block after that

G0514 only comes into play after G0513 is fully met and you’ve spent at least 16 more minutes (halfway threshold).

Example

• Total visit exceeds typical time by 45 minutes
  • G0513 = 30 minutes
  • G0514 = 1 unit (remaining 15+ minutes meets threshold)

Which Preventive Services Qualify As the Base for G0514?

CMS published a specific list of eligible preventive services in the 2018 Physician Fee Schedule final rule, titled “CY 2018 List of Preventive Services Billed with Prolonged Preventive Codes.” Each service has a CMS-assigned typical time, and the prolonged time clock starts only after that typical time is fully spent.

Qualifying base services include:

• G0402 (Welcome to Medicare visit)
• G0438 (Initial AWV)
• G0439 (Subsequent AWV)
• G0101 (cervical/vaginal cancer screening)
• G0105 (colonoscopy, high-risk)
• G0121 (colonoscopy, not high-risk)
• G0442 (annual alcohol misuse screening)
• G0444 (annual depression screening)

You cannot use G0513 or G0514 with non-covered preventive CPT codes like 99381-99397. Time spent on non-covered services cannot be reported under these codes. This is a critical distinction:

• if an OB-GYN performs a pelvic exam (G0101) on a Medicare patient and then continues with a full preventive medicine exam (99396), only the time associated with the G0101 service counts toward prolonged preventive billing
• the 99396 time is excluded because it is not a Medicare-covered service

When Can You Bill G0514 Without Getting Denied?

Three conditions must be met simultaneously:

• The base service must be a Medicare-covered preventive service with an assigned typical time
• G0513 must appear on the same claim with a full 30 minutes of prolonged time documented
• The provider must have spent at least 16 additional minutes of direct patient contact beyond the G0513 time block

National Government Services (NGS) has stated that these codes represent “relatively unusual circumstances” and should not appear routinely. High-frequency billing of G0514 across a practice will attract audit scrutiny.

Can Non-Physician Providers Bill G0514?

Yes.Non-Physician providers can bill G0514 when they independently perform and bill the qualifying base preventive service. Under their own NPI, Medicare pays at 85% of the physician fee schedule rate for the base code, G0513, and G0514.

However, NGS confirms these services “are not subject to incident-to billing.” The provider performing the prolonged service must be the same provider who performed and is billing the base preventive service.

 A physician cannot perform the AWV, leave, and have a nurse continue the visit with extra time billed as G0514 under the physician’s NPI.

How Much Time Is Required and What are the Unit Counts For G0514?

G0514 requires that the full 30 minutes of G0513 have been completed first, plus at least 16 additional minutes of direct patient contact. CMS adopted the CPT time rule: you must reach the halfway point plus one minute of each 30-minute block.

Here is the math applied to a real visit. If the typical time for the base preventive service is 30 minutes and the provider spends 76 minutes total:

• First 30 minutes: covered by the base code
• Minutes 31 to 60: 30 additional minutes = G0513 x 1
• Minutes 61 to 76: 16 additional minutes = G0514 x 1 (meets the halfway-plus-one threshold)

If the provider had spent only 74 minutes (14 additional minutes after G0513), G0514 would not be billable.

Only direct, face-to-face interaction between the provider and patient counts. Chart review, post-visit documentation, care coordination calls, or any activity outside the patient’s presence does not qualify. The time must also relate specifically to the preventive service. If a provider transitions into managing an acute complaint, that time belongs to a separate E/M code with modifier 25, not G0514.

There is no formal CMS cap on G0514 units, but billing 4 or more units (implying 2+ additional hours on a preventive visit) will almost certainly trigger review.

What Documentation Supports G0514?

The medical record must show four elements to support G0514:

• total time spent on the preventive service
• a clinical reason the extra time was needed
• what the provider did during the prolonged period
• confirmation that the time involved direct patient contact

NGS requires “a clinically valid reason for this extra use of time.” Vague notes like “complex visit” will not withstand audit review.

Strong documentation example: “Total visit time: 85 minutes. Initial AWV elements completed in first 40 minutes. Additional 45 minutes spent in direct patient contact addressing newly identified cognitive decline, reviewing fall risk results, coordinating neurology referral, discussing advance care planning with patient and daughter, and updating prevention plan for six new risk factors.”

Total time vs. start and stop time

CMS does not require start and stop times for G0513 or G0514. Total time documentation is sufficient for Medicare. However, many commercial insurers and Medicare Advantage plans require start and stop times. The safest approach: document both.

A provider documenting “Visit time: 80 minutes total” will satisfy Medicare. The same claim submitted to a Medicare Advantage plan requiring “Start: 9:00 AM, Stop: 10:20 AM” may be denied without those specifics.

How Is G0514 Different From G0513?

G0513 covers the first 30 minutes of prolonged preventive time. G0514 covers each additional 30-minute block after that. The hierarchy is strict: base preventive code + G0513 + G0514. You cannot bill G0514 without G0513, and you cannot bill G0513 without a qualifying base preventive service.

G0513 activates when the provider exceeds the standard service time by at least 16 minutes (the halfway-plus-one-minute threshold). G0514 stacks on top only after a full 30 minutes of G0513 time has been completed.

CMS Rules for Billing G0514 in 2026

Core billing rules for G0514 remain unchanged since its 2018 introduction. The 2026 Medicare conversion factor increased to $33.40 for non-qualifying APM participants and $33.57 for qualifying APM participants (increases of 3.26% and 3.77%). This affects payment amounts but not billing rules.

CMS finalized a -2.5% efficiency adjustment for select services in 2026, but time-based services are exempt. G0514 should not be subject to this reduction. Check the CMS Physician Fee Schedule Lookup Tool for current national and locality-adjusted rates.

How Much Does Medicare Reimburse for G0514?

For 2026, Medicare reimbursement for HCPCS code G0514 is:

• Non-facility (office setting): $65.12
• Facility (hospital/outpatient setting): $51.02
• Limiting charge (non-facility): $71.14
• Limiting charge (facility): $55.74

G0514 is an add-on code for each additional 30 minutes of prolonged preventive services beyond G0513.

Patient cost-sharing does not apply in G0514 because it is billed alongside Medicare-covered preventive services; coinsurance and deductibles are waived, meaning Medicare pays 100% of the allowed amount.

Each unit of G0514 adds approximately:

• ~$65 in non-facility settings
• ~$51 in facility settings

When billed appropriately with G0513:

• Total additional reimbursement is roughly $130+ (non-facility combined)

Medicare reimbursement is not uniform nationwide. Final payment varies based on the MAC (Medicare Administrative Contractor) locality & Geographic Practice Cost Index (GPCI) adjustments. Always verify the exact allowable amount for your specific region before billing.

How Is G0514 Different From CPT Prolonged Service Codes?

G0514 applies exclusively to Medicare-covered preventive services. CMS does not recognize CPT code 99417 for Medicare billing. Instead, CMS created G2212 for prolonged office E/M services. G0513/G0514 serves a parallel purpose for preventive services specifically.

The time rules differ. G2212 includes both face-to-face and non-face-to-face activities on the encounter date. G0513/G0514 counts only direct patient contact time.

Never use G0513/G0514 with standard E/M codes. Never use G2212 with preventive service codes. These code families are not interchangeable. G0514 should not appear on the same claim as G2212 for overlapping time periods.

Can G0514 Be Billed for Telehealth?

G0514’s descriptor specifies “in the office or other outpatient setting.” CMS has not explicitly added G0513 or G0514 to the Medicare telehealth services list as of 2026, though telehealth policy continues shifting. Some preventive services, including AWV components, can be delivered via telehealth. If the base service is covered via telehealth, check your MAC’s current guidance on whether prolonged add-on codes are also permitted.

Is There a Limit to How Many Times G0514 Can Be Billed?

There is no per-patient annual frequency limit on G0514 itself. However, the base preventive services it attaches to have their own frequency limits. AWVs are covered once every 12 months. Since G0514 can only be billed with a qualifying preventive visit, it inherits the base code’s frequency restriction.

Within a single visit, practical limits exist through Medically Unlikely Edits. Billing 4 or more units on one claim implies the provider spent over 2 additional hours on a preventive service beyond typical time. While not technically prohibited, this will almost certainly trigger review.

Do All Insurers Follow Medicare Rules for G0514?

No. G0514 is a HCPCS Level II code created specifically for Medicare. Commercial insurers, Medicaid, and Medicare Advantage plans are not required to follow Medicare’s rules. Some MA plans recognize and pay G0513/G0514; others do not. Commercial insurers typically use CPT prolonged service codes instead.

Verify coverage by checking the payer’s fee schedule or contacting provider relations before billing G0514 to any non-traditional Medicare payer.

What Are the Most Common Mistakes With G0514?

Most common mistaked when billing for G0514 is given below:

• Counting non-preventive time: If a provider spends 30 minutes on an AWV then 40 minutes managing chronic conditions, the 40 minutes belongs to a separate E/M code, not G0514.
• Billing G0514 without G0513: Always results in denial. Some EHR systems do not auto-link these codes, so coders must verify manually.
• Using G0514 with non-covered preventive services: CPT codes 99381-99397 are not Medicare-covered. Time spent on these cannot be captured with G0514.
• Failing to document clinical justification: A time entry alone is insufficient. The note must explain why prolonged service was necessary.
• Routine billing: High-frequency G0514 billing signals upcoding to auditors. These codes are for unusual situations, not standard practice.
• Rounding time up: If actual prolonged time beyond G0513 is 14 minutes, rounding to 16 to qualify for G0514 constitutes falsified documentation.

Pre-Submission Checklist for G0514

Use this four-step decision process to determine if G0514 applies:

1. Is the base service a Medicare-covered preventive service from the CMS list? If no, stop.
2. Did the visit exceed the typical service time for that base code? If no, stop.
3. Did the provider spend at least 16 minutes of direct patient contact beyond typical time? If yes, bill G0513.
4. After the full 30 minutes of G0513, did the provider spend at least 16 more minutes? If yes, bill G0514 x 1. Repeat for each additional block.

Before submitting the claim, verify:

• The base code is a CMS-eligible preventive service from the published list
• The patient meets eligibility requirements (enrollment timing, frequency limits)
• G0513 is present on the same claim
• Total visit time exceeds typical service time by at least 46 minutes (16 for G0513 threshold + 30 full G0513 minutes completed)
• Documentation includes total time, clinical justification, specific activities, and confirmation of direct patient contact
• The billing provider personally performed the prolonged service
• G0514 time does not overlap with time billed under a separate E/M code

Final Words

G0514 helps you capture the full value of long preventive visits, but only when you follow the rules closely. Always start with a valid base service, add G0513 first, and then use G0514 only when time truly qualifies. Focus on clear documentation and real medical needs. If you use it correctly, you avoid denials and recover revenue you already earned.