Question 1

What is HCPCS code G0413?

Accepted Answer

HCPCS code G0413 is "Pelvic ring fracture uni/bil". Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum)

Question 2

What category is G0413 in?

Accepted Answer

G0413 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0413?

Accepted Answer

Use G0413 when billing for pelvic ring fracture uni/bil. 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 G0413 covered by Medicare?

Accepted Answer

Coverage for G0413 (Pelvic ring fracture uni/bil) 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 G0413?

Accepted Answer

Documentation for G0413 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).