Question 1

What is HCPCS code G0534?

Accepted Answer

HCPCS code G0534 is "Coordinated care/or referral". Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, which significantly limit the ability to diagnose or treat an opioid use disorder; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)

Question 2

What category is G0534 in?

Accepted Answer

G0534 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0534?

Accepted Answer

Use G0534 when billing for coordinated care/or referral. 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

What ICD-10 codes are commonly used with G0534?

Accepted Answer

Common ICD-10 diagnosis codes used with G0534 include: F11.10 (Opioid abuse, uncomplicated), F11.11 (Opioid abuse, in remission), F11.120 (Opioid abuse with intoxication, uncomplicated), F11.121 (Opioid abuse with intoxication delirium). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is G0534 covered by Medicare?

Accepted Answer

Coverage for G0534 (Coordinated care/or referral) 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 6

What documentation is required for G0534?

Accepted Answer

Documentation for G0534 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).