How To Use HCPCS Code G0293

HCPCS code G0293 describes a noncovered surgical procedure(s) using conscious sedation, regional, general, or spinal anesthesia in a Medicare qualifying clinical trial, per day. This code is used to identify and bill for services that are not covered by Medicare but are performed as part of a clinical trial. In this article, we will explore the details of HCPCS code G0293, 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 G0293?

HCPCS code G0293 is a specific code used to identify noncovered surgical procedures performed under conscious sedation, regional, general, or spinal anesthesia in a Medicare qualifying clinical trial. It is important to note that this code is not applicable for procedures that are covered by Medicare outside of a clinical trial setting.

2. Official Description

The official description of HCPCS code G0293 is “Noncovered surgical procedure(s) using conscious sedation, regional, general or spinal anesthesia in a Medicare qualifying clinical trial, per day.” The short description for this code is “Non-cov surg proc, clin trial.”

3. Procedure

1. The provider begins by assessing the patient’s eligibility for participation in a Medicare qualifying clinical trial.
2. If the patient meets the eligibility criteria, the provider proceeds with the noncovered surgical procedure.
3. The procedure is performed using conscious sedation, regional, general, or spinal anesthesia, depending on the specific requirements of the surgical intervention.
4. The provider ensures that the procedure is performed in accordance with the protocols and guidelines of the clinical trial.
5. After the procedure, the provider documents the details of the surgical intervention, including the anesthesia used, in the patient’s medical records.

4. When to use HCPCS code G0293

HCPCS code G0293 should be used when a noncovered surgical procedure is performed under conscious sedation, regional, general, or spinal anesthesia as part of a Medicare qualifying clinical trial. It is important to verify the patient’s eligibility for the clinical trial and ensure that the procedure meets the specific criteria outlined in the trial protocol.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0293, healthcare providers need to ensure that the following documentation requirements are met:

• Documentation of the patient’s eligibility for the Medicare qualifying clinical trial.
• Documentation of the noncovered surgical procedure performed.
• Documentation of the anesthesia used during the procedure.
• Documentation of the clinical trial protocol followed during the procedure.

Providers should follow the standard billing guidelines for noncovered services and include the appropriate modifiers, if required, to indicate the use of conscious sedation, regional, general, or spinal anesthesia.

6. Historical Information and Code Maintenance

HCPCS code G0293 was added to the Healthcare Common Procedure Coding System on January 01, 2003. Since its addition, 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

HCPCS code G0293 is not covered by Medicare. It falls under the special coverage instructions category, indicated by the coverage code D. This means that specific coverage instructions apply, and providers need to follow the guidelines and requirements outlined by Medicare for billing and reimbursement.

Regarding pricing, HCPCS code G0293 is not separately priced by Part B. It is considered a service that is not covered, bundled, or used by Part A only. The pricing indicator code is 00, indicating that the service is not separately priced.

8. Examples

Here are five examples of when HCPCS code G0293 should be billed:

1. A patient is enrolled in a Medicare qualifying clinical trial for a noncovered surgical procedure that requires conscious sedation. The provider performs the procedure, and HCPCS code G0293 is used to bill for the service.
2. A patient is participating in a clinical trial that involves a noncovered surgical procedure under regional anesthesia. The provider performs the procedure, and HCPCS code G0293 is used for billing purposes.
3. In a Medicare qualifying clinical trial, a patient undergoes a noncovered surgical procedure under general anesthesia. The provider documents the details of the procedure and uses HCPCS code G0293 for billing.
4. A patient is enrolled in a clinical trial for a noncovered surgical procedure that requires spinal anesthesia. The provider performs the procedure, and HCPCS code G0293 is included on the claim for reimbursement.
5. In a Medicare qualifying clinical trial, a patient undergoes multiple noncovered surgical procedures on the same day, all performed under conscious sedation. The provider bills for each procedure using HCPCS code G0293.