Question 1

What is HCPCS code G0536?

Accepted Answer

HCPCS code G0536 is "Peer recover support svs". Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes; developing and proposing strategies to help meet person-centered treatment goals; assisting the patient in locating or navigating recovery support services; 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 G0536 in?

Accepted Answer

G0536 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0536?

Accepted Answer

Use G0536 when billing for peer recover support svs. 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 G0536?

Accepted Answer

Common ICD-10 diagnosis codes used with G0536 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 G0536 covered by Medicare?

Accepted Answer

Coverage for G0536 (Peer recover support svs) 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 G0536?

Accepted Answer

Documentation for G0536 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).