HCPCS G0513: Prolonged preventive careMedicare rate & RVUs
G0513 reports the first 30 minutes of preventive work that extends beyond the usual time for a Medicare annual wellness visit.
Medicare pays $64.80 for G0513 nationally in the office and $50.77 in a hospital or facility. Local office rates run $60.37–$84.81.
Medicare rate · G0513
Prolonged preventive care
Swap in your local Medicare rate.
- Work RVUs
- 1.17
- Total RVUs
- 1.94
- Global days
- ZZZ
National rate · 2026
$64.80
Office setting, before claim adjustments.
See every locality for G0513 → · 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.
On this page 10 sections
What G0513 covers
G0513 captures additional direct work by a physician or other qualified health care professional when a Medicare annual wellness visit requires substantially more preventive service than the usual visit. Examples include extended discussion of screening needs, risk reduction, or a prevention plan during an initial or subsequent annual wellness visit. The added work must be preventive and distinct from the ordinary components of the visit; routine time spent completing the wellness visit itself is not prolonged service time.
Report G0513 as an add-on with the primary preventive service, commonly the initial or subsequent annual wellness visit, G0438 or G0439. Documentation should identify the preventive work performed and the time beyond the usual service that supports the first 30-minute increment. G0513 is not a stand-alone service. Under the CMS rule provided, it is paid within the primary procedure's global period. For additional prolonged time, G0514 is the related additional-time code.
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 G0513 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
$60.37 to $84.81
109 of 109 payment localities
G0513 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.
$60.37
$84.81
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 | $84.81 | 1 |
| AL | $60.86 | 1 |
| AR | $60.37 | 1 |
| AZ | $63.74 | 1 |
| CA | $66.62–$78.35 | 29 |
| CO | $66.25 | 1 |
| CT | $67.87 | 1 |
| DC | $71.33 | 1 |
| DE | $64.48 | 1 |
| FL | $64.95–$69.33 | 3 |
| GA | $62.72–$65.76 | 2 |
| GU | $67.02 | 1 |
| HI | $67.02 | 1 |
| IA | $61.40 | 1 |
| ID | $61.70 | 1 |
| IL | $64.08–$68.22 | 4 |
| IN | $61.89 | 1 |
| KS | $61.39 | 1 |
| KY | $62.00 | 1 |
| LA | $62.01–$63.74 | 2 |
| MA | $66.19–$70.68 | 2 |
| MD | $65.28–$71.33 | 3 |
| ME | $62.04–$63.72 | 2 |
| MI | $63.07–$65.58 | 2 |
| MN | $63.83 | 1 |
| MO | $61.51–$63.68 | 3 |
| MS | $60.94 | 1 |
| MT | $64.79 | 1 |
| NC | $62.39 | 1 |
| ND | $63.41 | 1 |
| NE | $61.54 | 1 |
| NH | $65.46 | 1 |
| NJ | $68.74–$71.16 | 2 |
| NM | $63.33 | 1 |
| NV | $64.43 | 1 |
| NY | $62.93–$73.72 | 5 |
| OH | $62.78 | 1 |
| OK | $61.77 | 1 |
| OR | $64.01–$67.42 | 2 |
| PA | $62.75–$66.91 | 2 |
| PR | $65.02 | 1 |
| RI | $66.06 | 1 |
| SC | $62.67 | 1 |
| SD | $63.25 | 1 |
| TN | $61.59 | 1 |
| TX | $62.53–$65.97 | 8 |
| UT | $63.16 | 1 |
| VA | $63.71–$71.33 | 2 |
| VI | $65.02 | 1 |
| VT | $63.41 | 1 |
| WA | $65.99–$71.63 | 2 |
| WI | $62.20 | 1 |
| WV | $62.74 | 1 |
| WY | $64.19 | 1 |
How the G0513 rate is calculated
Each of G0513’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 · G0513
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.17Practice expense 0.70Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G0513
The CMS indicators that decide how G0513 is paid alongside other services.
CMS payment indicators · G0513
Prolonged preventive care
| 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. |
G0513 compared with similar codes
Compare codes
G0513 vs G0514 vs G0438 vs G0439 vs 99417: national Medicare rates
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How to choose
- G0514Prolonged preventive service
- G0513 covers the first 30-minute increment of prolonged preventive service; G0514 covers additional 30-minute increments.
- G0438Annual wellness visit
- G0438 reports the initial annual wellness visit itself. G0513 is an add-on for qualifying preventive work beyond the usual visit.
- G0439Annual wellness visit
- G0439 reports a subsequent annual wellness visit. G0513 reports additional prolonged preventive work when paired with the primary service.
- 99417Prolng op e/m each 15 min
- 99417 is associated with prolonged office or outpatient E/M services; G0513 is for prolonged preventive service, commonly with an annual wellness visit.
G0513 billing questions
Which annual wellness visit codes are paired with G0513?
G0513 is commonly paired with G0438 for an initial annual wellness visit or G0439 for a subsequent annual wellness visit. It reports qualifying preventive work beyond the usual visit.
Can G0513 be billed by itself?
No. It is an add-on code and must be reported with a primary procedure. CMS pays it within that procedure's global period.
When should G0514 be used instead?
G0513 represents the first 30-minute increment of prolonged preventive service. G0514 is the related code for additional 30-minute increments.
What documentation supports G0513?
Document the preventive work beyond the usual annual wellness visit and the time attributable to that additional work. The record should distinguish it from time spent on routine visit elements.
Is G0513 the prolonged-service code for a regular office E/M visit?
No. G0513 is for prolonged preventive service, commonly with an annual wellness visit. Prolonged office or outpatient E/M work uses a different code family when applicable.
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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