Question 1

What is HCPCS code G0042?

Accepted Answer

HCPCS code G0042 is "Ref to therapy". Referral to physical, occupational, speech, or recreational therapy

Question 2

What category is G0042 in?

Accepted Answer

G0042 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0042?

Accepted Answer

Use G0042 when billing for ref to therapy. 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 G0042 covered by Medicare?

Accepted Answer

Coverage for G0042 (Ref to therapy) 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 G0042?

Accepted Answer

Documentation for G0042 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).