HCPCS code G0316: Prolonged E/M2026 Medicare rate & RVUs
Reports qualifying time beyond an eligible hospital inpatient or observation E/M service when the physician or qualified health professional provides extended care.
Medicare pays $34.74 for G0316 nationally in the office and $27.72 in a hospital or facility. Local office rates run $32.14–$45.00.
Medicare rate · G0316
Prolonged E/M
- Work RVUs
- 0.61
- Total RVUs
- 1.04
- Global days
- ZZZ
National rate · 2026
$34.74
Office setting, before claim adjustments.
See every locality for G0316 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What G0316 covers
G0316 represents additional physician or qualified health professional time spent on hospital inpatient or observation evaluation and management beyond the time for an eligible primary service. It may accompany an initial hospital care service, a subsequent hospital care service, or same-day admission and discharge care. The work may include continued assessment, review of clinical information, treatment planning, and coordination related to the patient’s hospital care. It is used for care in hospital inpatient and observation settings, not for prolonged nursing facility or home E/M services.
Report G0316 only with an eligible primary service, such as 99223, 99233, or 99236; it is not a stand-alone service. Select the primary E/M code under the applicable visit rules, then report G0316 for documented qualifying time beyond that service’s time threshold, in the additional intervals required for the add-on. Documentation should support the total time on the date of service and the work performed. CMS treats G0316 as an add-on paid within the primary procedure’s global period.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where G0316 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$32.14 to $45.00
109 of 109 payment localities
G0316 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$32.14
$45.00
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $45.00 | 1 |
| AL | $32.43 | 1 |
| AR | $32.14 | 1 |
| AZ | $34.10 | 1 |
| CA | $35.53–$41.81 | 29 |
| CO | $35.43 | 1 |
| CT | $36.47 | 1 |
| DC | $38.29 | 1 |
| DE | $34.52 | 1 |
| FL | $35.02–$37.81 | 3 |
| GA | $33.69–$35.34 | 2 |
| GU | $35.77 | 1 |
| HI | $35.77 | 1 |
| IA | $32.65 | 1 |
| ID | $32.84 | 1 |
| IL | $34.57–$37.11 | 4 |
| IN | $32.95 | 1 |
| KS | $32.69 | 1 |
| KY | $33.19 | 1 |
| LA | $33.21–$34.22 | 2 |
| MA | $35.40–$37.85 | 2 |
| MD | $34.96–$38.29 | 3 |
| ME | $33.09–$34.01 | 2 |
| MI | $33.85–$35.44 | 2 |
| MN | $33.93 | 1 |
| MO | $32.94–$34.13 | 3 |
| MS | $32.54 | 1 |
| MT | $34.73 | 1 |
| NC | $33.28 | 1 |
| ND | $33.74 | 1 |
| NE | $32.72 | 1 |
| NH | $35.05 | 1 |
| NJ | $36.88–$38.16 | 2 |
| NM | $34.02 | 1 |
| NV | $34.47 | 1 |
| NY | $33.61–$39.87 | 5 |
| OH | $33.65 | 1 |
| OK | $33.01 | 1 |
| OR | $34.19–$36.04 | 2 |
| PA | $33.60–$35.95 | 2 |
| PR | $34.85 | 1 |
| RI | $35.36 | 1 |
| SC | $33.52 | 1 |
| SD | $33.63 | 1 |
| TN | $32.81 | 1 |
| TX | $33.48–$35.44 | 8 |
| UT | $33.81 | 1 |
| VA | $34.03–$38.29 | 2 |
| VI | $34.85 | 1 |
| VT | $33.79 | 1 |
| WA | $35.28–$38.33 | 2 |
| WI | $33.05 | 1 |
| WV | $33.79 | 1 |
| WY | $34.30 | 1 |
How the G0316 rate is calculated
Each of G0316’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · G0316
RVUs × geographic indexes × conversion factor
Work0.61
0.61 RVUs× 1.000 GPCI
Practice expense0.38
0.38 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
1.0400
Conversion factor
$33.4009
Medicare rate
$34.74
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for G0316
The CMS indicators that decide how G0316 is paid alongside other services.
CMS payment indicators · G0316
Prolonged E/M
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
G0316 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99233Hospital follow-up visit
- 99233 reports the subsequent hospital or observation E/M service itself. Add G0316 only when qualifying time extends beyond the primary service’s time threshold.
- G0317Prolonged E/M
- G0317 is for prolonged nursing facility E/M time; G0316 is for hospital inpatient or observation care.
- G0318Prolonged home visit
- G0318 is for prolonged E/M in a home or residence setting; G0316 is for hospital inpatient or observation care.
G0316 billing questions
Which primary E/M codes can be paired with G0316?
G0316 is reported with eligible hospital inpatient or observation care services, including 99223, 99233, and 99236. It cannot be submitted by itself.
When does the documented time support G0316?
The primary service’s time requirement must be met, with qualifying additional time beyond its threshold for each reported add-on interval. Document the total time and the work performed.
Can time for a separately billed service count toward G0316?
Do not count time spent on a separately reported service toward the prolonged E/M time. The documentation should make the time attributable to the E/M work clear.
Should G0316 be used for prolonged nursing facility care?
No. G0316 is for hospital inpatient or observation care; G0317 is the related prolonged-service code for nursing facility E/M.
How does CMS pay G0316?
CMS treats G0316 as an add-on code paid within the primary procedure’s global period. It must be billed with an eligible primary E/M service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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