Question 1

What is HCPCS code G0516?

Accepted Answer

HCPCS code G0516 is "Insert drug del implant, >=4". Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)

Question 2

What category is G0516 in?

Accepted Answer

G0516 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0516?

Accepted Answer

Use G0516 when billing for insert drug del implant, >=4. 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 G0516 covered by Medicare?

Accepted Answer

Coverage for G0516 (Insert drug del implant, >=4) 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 G0516?

Accepted Answer

Documentation for G0516 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).