Question 1

What is HCPCS code G0528?

Accepted Answer

HCPCS code G0528 is "Mgt est pt dem mod-hi cmplx". Management of established patient with dementia, moderate to high complexity, for use in cmmi model

Question 2

What category is G0528 in?

Accepted Answer

G0528 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0528?

Accepted Answer

Use G0528 when billing for mgt est pt dem mod-hi cmplx. 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 G0528 covered by Medicare?

Accepted Answer

Coverage for G0528 (Mgt est pt dem mod-hi cmplx) 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 G0528?

Accepted Answer

Documentation for G0528 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).