Question 1

What is HCPCS code G0138?

Accepted Answer

HCPCS code G0138 is "Iv cipaglucosidase alfa-atga". Intravenous infusion of cipaglucosidase alfa-atga, including provider/supplier acquisition and clinical supervision of oral administration of miglustat in preparation of receipt of cipaglucosidase alfa-atga

Question 2

What category is G0138 in?

Accepted Answer

G0138 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0138?

Accepted Answer

Use G0138 when billing for iv cipaglucosidase alfa-atga. 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 G0138 covered by Medicare?

Accepted Answer

Coverage for G0138 (Iv cipaglucosidase alfa-atga) 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 G0138?

Accepted Answer

Documentation for G0138 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).