Medicare Reimbursement for G0513 – Prolonged Preventive Services (First 30 Minutes)

HCPCS code G0513 is used to report the first 30 minutes of prolonged preventive service time furnished in conjunction with a covered preventive visit. This page shows the estimated Medicare Physician Fee Schedule (PFS) allowed amount for this code, both nationally and by locality, with separate figures for non-facility (e.g., office) and facility (e.g., hospital) settings.

Medicare allowed amount (2026)

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. Units above the MUE are denied; some MUEs can be exceeded only with appropriate documentation and modifiers where policy allows.

How the amount is calculated

Medicare's PFS payment is built from three Relative Value Units (RVUs) — work, practice expense (PE), and malpractice (MP) — assigned to the code. Each RVU component is adjusted by locality-specific Geographic Practice Cost Indices (GPCIs) to reflect regional cost differences, then the adjusted RVUs are summed and multiplied by the annual national conversion factor to produce a dollar amount. Practice-expense RVUs differ between non-facility and facility settings because overhead costs (staff, supplies, equipment) are higher when a service is performed in a physician's own office versus a hospital or facility setting. These calculations are updated annually and can shift due to policy changes even if the RVUs themselves stay the same.

RVUs — work 1.17, practice expense 0.7 (non-facility) / 0.28 (facility), malpractice 0.07 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

• This is an estimate only, not a guarantee of payment.
• Medicare typically pays 80% of the allowed amount after the patient meets their Part B deductible; the patient or secondary insurer is responsible for the remainder.
• Actual payment can vary by locality, applicable modifiers, claims-processing edits, sequestration reductions, and annual budget-neutrality adjustments.
• Always verify current rates and coverage rules with your Medicare Administrative Contractor (MAC) before billing.

Frequently asked

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Estimated Medicare Physician Fee Schedule amount. Medicare generally pays 80% after the deductible; actual amounts vary by locality, modifiers, sequestration, and annual updates. Verify with your MAC.