Wiki Prolonged Modifiers

Hello
I currently code for a Palliative Care group who provides both E/M visits as well as prolonged services. Any tips on what modifiers could be used when coding a inpatient, home, office E/M service with a prolonged service G0316, G0317, G0318, G2212, and G2211?

What modifiers are needed to show the insurance that the prolonged service is separate from the E/M?
Would the modifier need to be on the E/M or the Add-on?

Hi there, Please review the full descriptors for codes G0316, G0317, G0318 and G2212. The descriptors include the language "list separately in addition to CPT codes" to indicate they should be reported with the primary E/M service. You'll find more information on prolonged service coding in this CMS manual:

www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf

G2211 is not a prolonged service code.

Hello,
I am new to coding Palliative care services and urgently looking for the details for 2024.Our provider is looking to provide these services in an assisted living facility.
Can one of you confirm if the below information is correct?
1. POS will be 12
2. CPT codes are New (99341- 99345) and Est (99347 - 99350)

- Can I add G2211 along with these codes above?
- Do I need to know anything else before we start this process?
- Also, any documentation suggestions on these services will be helpful.

Please advise.

jordynn6736 said:

Hello
I currently code for a Palliative Care group who provides both E/M visits as well as prolonged services. Any tips on what modifiers could be used when coding a inpatient, home, office E/M service with a prolonged service G0316, G0317, G0318, G2212, and G2211?

What modifiers are needed to show the insurance that the prolonged service is separate from the E/M?
Would the modifier need to be on the E/M or the Add-on?

Click to expand...

Did you get a valid response? I'm wondering the same thing. I think they both can use modifier 25 but wanted to get a valid source

looking for Oct 2024 new CPT code changes for prolonged codes- for nursing home used to G0317/8 did these change?