Question 1

What is HCPCS code G0294?

Accepted Answer

HCPCS code G0294 is "Non-cov proc, clinical trial". Noncovered procedure(s) using either no anesthesia or local anesthesia only, in a medicare qualifying clinical trial, per day

Question 2

What category is G0294 in?

Accepted Answer

G0294 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0294?

Accepted Answer

Use G0294 when billing for non-cov proc, clinical trial. 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 G0294 covered by Medicare?

Accepted Answer

Coverage for G0294 (Non-cov proc, clinical trial) 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 G0294?

Accepted Answer

Documentation for G0294 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).