Medicare Prolonged Services Time Chart
Medicare does not pay 99417 or 99418. It uses its own codes and counts prolonged time from a higher starting point. These thresholds come from the CMS Evaluation and Management Services guide (MLN006764, May 2026).
| Primary visit | Visit time | Prolonged code | First unit at | More units at |
|---|---|---|---|---|
| Office visit, new patient (99205) | 60 minutes | G2212 | 89 minutes | 104, 119, 134 |
| Office visit, established patient (99215) | 40 minutes | G2212 | 69 minutes | 84, 99, 114 |
| Cognitive assessment and care planning (99483) | See CPT | G2212 | 100 minutes | 115, 130, 145 |
| Initial hospital inpatient or observation (99223) | 75 minutes | G0316 | 90 minutes | 105, 120, 135 |
| Subsequent hospital inpatient or observation (99233) | See CPT | G0316 | 65 minutes | 80, 95, 110 |
| Same-day admission and discharge (99236) | See CPT | G0316 | 110 minutes | 125, 140, 155 |
| Initial nursing facility visit (99306) | See CPT | G0317 | 95 minutes | 110, 125, 140 |
| Subsequent nursing facility visit (99310) | 45 minutes | G0317 | 85 minutes | 100, 115, 130 |
| Home or residence visit, new patient (99345) | 75 minutes | G0318 | 140 minutes | 155, 170, 185 |
| Home or residence visit, established patient (99350) | 60 minutes | G0318 | 110 minutes | 125, 140, 155 |
CPT 99417 and 99418 Time Chart (Most Other Payers)
Under CPT rules, a prolonged unit starts 15 minutes after the primary code's required time. Check your payer's policy, because some commercial and Medicare Advantage plans follow the Medicare G codes instead.
| Primary visit | Visit time | Prolonged code | First unit at | More units at |
|---|---|---|---|---|
| Office visit, new patient (99205) | 60 minutes | 99417 | 75 minutes | 90, 105, 120 |
| Office visit, established patient (99215) | 40 minutes | 99417 | 55 minutes | 70, 85, 100 |
| Initial hospital inpatient or observation (99223) | 75 minutes | 99418 | 90 minutes | 105, 120, 135 |
| Subsequent nursing facility visit (99310) | 45 minutes | 99418 | 60 minutes | 75, 90, 105 |
| Home or residence visit, new patient (99345) | 75 minutes | 99417 | 90 minutes | 105, 120, 135 |
| Home or residence visit, established patient (99350) | 60 minutes | 99417 | 75 minutes | 90, 105, 120 |
Why Medicare and CPT Differ
For a 99215, CPT starts the first prolonged unit at 55 minutes (40 plus 15). Medicare starts at 69 minutes, because it counts 15 minutes past the top of the old 40 to 54 minute range. The same 60-minute visit earns a 99417 from a commercial payer but no G2212 from Medicare.
Rules That Apply to Every Prolonged Code
- You must select the visit level by time, not by medical decision making.
- Bill prolonged time only with the highest level visit in each family.
- Each unit needs a full 15 minutes. Do not report a unit for less than 15 minutes.
- Count only the billing provider's time, not staff time, and only medically necessary work.
- For Medicare, do not report G2212 on the same date as 99358, 99359, 99415 or 99416.
- Write the total minutes, and what they were spent on, in the note.
What Counts as Time
Count the provider's time on the activities listed in the AMA E/M guidelines: preparing to see the patient, reviewing tests and records, getting a history, the exam, counseling, ordering, talking with other professionals, writing the note and coordinating care. Travel time and separately billed services do not count.
What Prolonged Time Pays
| Code | Medicare 2026, non-facility | Medicare 2026, facility |
|---|---|---|
| G2212 | $34.07 | $27.39 |
| G0316 | $34.74 | $27.72 |
| G0317 | $33.73 | $27.05 |
| G0318 | $34.07 | $27.39 |
National amounts at the $33.4009 conversion factor, per unit. See your local rate in the Medicare fee lookup. For choosing the visit level itself, see 99214 vs 99215 and the E/M calculator.
Frequently Asked Questions
Written by Hassan Raza Awan
Founder — LegitMedBilling & IT Solutions
Hassan has 4+ years of hands-on U.S. medical billing experience — working claims, denials, credentialing, and payer follow-up for practices across the United States. Every guide he publishes is written from real remittances and payer behavior, not theory.
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