Question 1

What is HCPCS code G0563?

Accepted Answer

HCPCS code G0563 is "Sbrt w/positron emission del". Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions

Question 2

What category is G0563 in?

Accepted Answer

G0563 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0563?

Accepted Answer

Use G0563 when billing for sbrt w/positron emission del. 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 G0563?

Accepted Answer

Common ICD-10 diagnosis codes used with G0563 include: C00.0 (Malignant neoplasm of external upper lip), C00.1 (Malignant neoplasm of external lower lip), C00.2 (Malignant neoplasm of external lip, unspecified), C00.3 (Malignant neoplasm of upper lip, inner aspect). Always ensure proper medical documentation supports the medical necessity for the HCPCS code being billed.

Question 5

Is G0563 covered by Medicare?

Accepted Answer

Coverage for G0563 (Sbrt w/positron emission del) 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 G0563?

Accepted Answer

Documentation for G0563 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).