Question 1

What is HCPCS code G0415?

Accepted Answer

HCPCS code G0415 is "Open tx post pelvic fxcture". Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)

Question 2

What category is G0415 in?

Accepted Answer

G0415 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0415?

Accepted Answer

Use G0415 when billing for open tx post pelvic fxcture. 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 G0415 covered by Medicare?

Accepted Answer

Coverage for G0415 (Open tx post pelvic fxcture) 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 G0415?

Accepted Answer

Documentation for G0415 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).