Question 1

What is HCPCS code G0535?

Accepted Answer

HCPCS code G0535 is "Pt navigat svs direct/ref". Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; 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 G0535 in?

Accepted Answer

G0535 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0535?

Accepted Answer

Use G0535 when billing for pt navigat svs direct/ref. 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 G0535?

Accepted Answer

Common ICD-10 diagnosis codes used with G0535 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 G0535 covered by Medicare?

Accepted Answer

Coverage for G0535 (Pt navigat svs direct/ref) 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 G0535?

Accepted Answer

Documentation for G0535 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).