How To Use HCPCS Code G0055

HCPCS code G0055 describes the advancement of care for heart disease through the MIPS Value Pathways. This code is used to identify and bill for services related to the management and treatment of heart disease. In this article, we will explore the details of HCPCS code G0055, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0055?

HCPCS code G0055 is a specific code used to identify and bill for services related to advancing care for heart disease through the MIPS Value Pathways. It is important to note that this code is specific to the management and treatment of heart disease and should not be used for other conditions or procedures.

2. Official Description

The official description of HCPCS code G0055 is “Advancing care for heart disease MIPS Value Pathways.” The short description is “Adv care heart dx mvp.” This description accurately reflects the purpose and scope of this code.

3. Procedure

1. Providers should follow the MIPS Value Pathways guidelines for advancing care for heart disease.
2. This may include various interventions, treatments, and management strategies tailored to the specific needs of the patient.
3. Providers should document all relevant procedures and services provided in the patient’s medical record.
4. It is important to ensure accurate and detailed documentation to support the use of HCPCS code G0055.

4. When to use HCPCS code G0055

HCPCS code G0055 should be used in the context of advancing care for heart disease through the MIPS Value Pathways. It is important to ensure that the services provided align with the specific guidelines and requirements outlined in the MIPS Value Pathways for heart disease management.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G0055, healthcare providers should ensure that the following guidelines and documentation requirements are met:

• Accurate and detailed documentation of the services provided
• Documentation supporting the use of HCPCS code G0055
• Compliance with the MIPS Value Pathways guidelines for heart disease management
• Proper coding and submission of claims

6. Historical Information and Code Maintenance

HCPCS code G0055 was added to the Healthcare Common Procedure Coding System on January 01, 2022. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

Medicare and insurance coverage for HCPCS code G0055 may vary. It is important to check with the specific payer for their coverage policies and guidelines. The pricing indicator code for HCPCS code G0055 is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers. The multiple pricing indicator code is 9, which indicates that the value for this code is not established or not applicable.

8. Examples

Here are five examples of when HCPCS code G0055 should be billed:

1. A patient with a history of heart disease receives a comprehensive evaluation and management visit focused on optimizing their care and treatment plan.
2. A cardiologist performs a cardiac catheterization procedure to assess the extent of blockages in a patient’s coronary arteries and determine the appropriate treatment approach.
3. A primary care physician provides counseling and education to a patient with heart disease on lifestyle modifications, medication adherence, and self-care management.
4. A cardiac rehabilitation program provides exercise training, education, and support to a patient recovering from a recent heart procedure or event.
5. A cardiovascular surgeon performs a coronary artery bypass graft surgery to improve blood flow to the heart muscle in a patient with severe coronary artery disease.