Question 1

What is HCPCS code G0037?

Accepted Answer

HCPCS code G0037 is "Pt not able to participate". On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available

Question 2

What category is G0037 in?

Accepted Answer

G0037 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0037?

Accepted Answer

Use G0037 when billing for pt not able to participate. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G0037 covered by Medicare?

Accepted Answer

Coverage for G0037 (Pt not able to participate) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G0037?

Accepted Answer

Documentation for G0037 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).