Showing codes G0512 (Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month) — G0542 (Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) (use g0542 in conjunction with g0541))

G0512 - Cocm by rhc/fqhc 60 min mo
Long description: Rural health clinic or federally qualified health center (rhc/fqhc) only, psychiatric collaborative care model (psychiatric cocm), 60 minutes or more of clinical staff time for psychiatric cocm services directed by an rhc or fqhc practitioner (physician, np, pa, or cnm) and including services furnished by a behavioral health care manager and consultation with a psychiatric consultant, per calendar month
Code added date: 20180101.
Code effective date: 20180101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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G0513 - Prolong prev svcs, first 30m
Long description: Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)
Code added date: 20180101.
Code effective date: 20180101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0514 - Prolong prev svcs, addl 30m
Long description: Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code g0513 for additional 30 minutes of preventive service)
Code added date: 20180101.
Code effective date: 20180101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0515 - Cognitive skills development
Long description: Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
Code added date: 20180101.
Code effective date: 20200101.
Pricing Indicator Code(s): 11 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0516 - Insert drug del implant, >=4
Long description: Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)
Code added date: 20180101.
Code effective date: 20180401.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0517 - Remove drug implant
Long description: Removal of non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
Code added date: 20180101.
Code effective date: 20180101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0518 - Remove w insert drug implant
Long description: Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
Code added date: 20180101.
Code effective date: 20180101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0519 - New pt-cg dyad dem low cmplx
Long description: Management of new patient-caregiver dyad with dementia, low complexity, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0520 - New pt-cg dyad dem mod cmplx
Long description: Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0521 - New pt-cg dyad dem hig cmplx
Long description: Management of new patient-caregiver dyad with dementia, high complexity, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0522 - Mgt nw pt dementia low cmplx
Long description: Management of a new patient with dementia, low complexity, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0523 - Mgt nw pt dem mod-high cmplx
Long description: Management of a new patient with dementia, moderate to high complexity, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0524 - Est pt-cg dyad dem low cmplx
Long description: Management of established patient-caregiver dyad with dementia, low complexity, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0525 - Est pt-cg dyad dem mod cmplx
Long description: Management of established patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0526 - Est pt-cg dyad dem hig cmplx
Long description: Management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0527 - Mgt est pt dmentia low cmplx
Long description: Management of established patient with dementia, low complexity, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0528 - Mgt est pt dem mod-hi cmplx
Long description: Management of established patient with dementia, moderate to high complexity, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0529 - In home respite care, 4 hr u
Long description: In-home respite care, 4-hour unit, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0530 - Adult daycare center, 8 hr u
Long description: Adult day center, 8-hour unit, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0531 - Fclty-based respite, 24 hr u
Long description: Facility-based respite, 24-hour unit, for use in cmmi model
Code added date: 20240701.
Code effective date: 20240701.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0532 - Take home supp nasal spray
Long description: Take-home supply of nasal nalmefene hydrochloride; one carton of two, 2.7 mg per 0.1 ml nasal sprays (provision of the services by a medicare-enrolled opioid treatment program);( list separately in addition to each primary code)
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 11 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0533 - Buprenorphone inj weekly
Long description: Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0534 - Coordinated care/or referral
Long description: Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, which significantly limit the ability to diagnose or treat an opioid use disorder; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0535 - Pt navigat svs direct/ref
Long description: Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0536 - Peer recover support svs
Long description: Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes; developing and proposing strategies to help meet person-centered treatment goals; assisting the patient in locating or navigating recovery support services; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0537 - Risk ascvd tst once pr 12 mo
Long description: Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0538 - Ascvd rsk mng clin stf pr mo
Long description: Atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar month
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0539 - Initial care training 30 m
Long description: Caregiver training in behavior management/modification for caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; initial 30 minutes
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0540 - Train for caregiver add 15
Long description: Caregiver training in behavior management/modification for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; each additional 15 minutes
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0541 - No pt prsnt train initial 30
Long description: Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; initial 30 minutes
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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G0542 - No pt prsnt train add 15
Long description: Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not limited to, techniques to prevent decubitus ulcer formation, wound care, and infection control) (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) (use g0542 in conjunction with g0541)
Code added date: 20250101.
Code effective date: 20250101.
Pricing Indicator Code(s): 13 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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