No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
G0316 Prolonged E/M Medicare reimbursement rates in Washington
Reports qualifying time beyond an eligible hospital inpatient or observation E/M service when the physician or qualified health professional provides extended care. Compare G0316 office and facility rates across CMS payment localities in Washington.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for G0316 in Washington?
Washington has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$35.28–$38.33
2 of 2 localities have a supported rate.
Facility setting
$27.89–$29.72
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Evaluation and management
About G0316: Prolonged inpatient or observation E/M
Reports qualifying time beyond an eligible hospital inpatient or observation E/M service when the physician or qualified health professional provides extended care.
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.
CMS billing rules for G0316
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU0.61 · 59%
- Practice expense (office) RVU0.38 · 37%
- Malpractice RVU0.05 · 5%
512.7K
Medicare services in 2024 · #226 by national volume
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.
G0316 compared with similar codes
Office rates for Washington, from the same CMS release.
$34.32–$37.24
G0317 is for prolonged nursing facility E/M time; G0316 is for hospital inpatient or observation care.
$34.57–$37.51
G0318 is for prolonged E/M in a home or residence setting; G0316 is for hospital inpatient or observation care.
Compare G0316 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Rest Of Washington →
Office / nonfacility
$35.28
Facility
$27.89
Seattle (King Cnty) →
Office / nonfacility
$38.33
Facility
$29.72
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
15,190G0313,,Immunize couns < 21yr 6-30 m,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,191G0314,,Counsel immune <21 16-30 m,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,192G0315,,Counsel immune <21 5-15 m,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,193G0316,,Prolong inpt eval add15 m,A,,0.61,0.38,,0.17,,0.05,1.04,0.83,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,194G0317,,Prolong nursin fac eval 15m,A,,0.61,0.36,,0.16,,0.04,1.01,0.81,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,195G0318,,Prolong home eval add 15m,A,,0.61,0.36,,0.16,,0.05,1.02,0.82,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,196G0320,,Two-way audio and video hhs,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00