How To Use HCPCS Code G1028

HCPCS code G1028 describes the provision of a take-home supply of nasal naloxone. This code specifically refers to a 2-pack of 8mg per 0.1 ml nasal spray provided by a Medicare-enrolled opioid treatment program. It is important to note that this code should be listed separately in addition to the code for the primary procedure.

1. What is HCPCS G1028?

HCPCS code G1028 is used to identify the provision of a take-home supply of nasal naloxone. Naloxone is a medication used to reverse the effects of opioid overdose. This specific code refers to a 2-pack of 8mg per 0.1 ml nasal spray. It is important to note that this code is specific to Medicare-enrolled opioid treatment programs.

2. Official Description

The official description of HCPCS code G1028 is “Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a Medicare-enrolled opioid treatment program).” The short description of this code is “Take home supply 8mg per 0.1.”

3. Procedure

1. The provider must ensure that the patient meets the eligibility criteria for receiving a take-home supply of nasal naloxone.
2. The provider should educate the patient on the proper use of the nasal naloxone spray and provide any necessary instructions or demonstrations.
3. The provider should dispense a 2-pack of the nasal naloxone spray, with each spray containing 8mg per 0.1 ml.
4. The provider should document the provision of the take-home supply of nasal naloxone in the patient’s medical record.

4. When to use HCPCS code G1028

HCPCS code G1028 should be used when a Medicare-enrolled opioid treatment program provides a take-home supply of nasal naloxone to a patient. It is important to ensure that the patient meets the eligibility criteria for receiving this supply.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G1028, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s eligibility for receiving a take-home supply of nasal naloxone
• Documentation of the education provided to the patient regarding the proper use of the nasal naloxone spray
• Documentation of the dispensing of the 2-pack of nasal naloxone spray
• Documentation of the provision of the service by a Medicare-enrolled opioid treatment program

6. Historical Information and Code Maintenance

HCPCS code G1028 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

The coverage of HCPCS code G1028 is determined by Medicare and other insurance providers. The pricing indicator code for this code is 11, which means that the price is established using national RVUs (Relative Value Units). The multiple pricing indicator code for this code is A, which means it is not applicable as HCPCS is priced under one methodology.

8. Examples

Here are five examples of when HCPCS code G1028 should be billed:

1. A Medicare-enrolled opioid treatment program provides a 2-pack of 8mg per 0.1 ml nasal naloxone spray to a patient who meets the eligibility criteria.
2. A patient receives a take-home supply of nasal naloxone from a Medicare-enrolled opioid treatment program after completing a treatment program.
3. A patient is discharged from a Medicare-enrolled opioid treatment program and is provided with a take-home supply of nasal naloxone for continued support.
4. A patient who is receiving opioid treatment at a Medicare-enrolled program is given a take-home supply of nasal naloxone as a precautionary measure.
5. A patient who has completed a detoxification program at a Medicare-enrolled opioid treatment program is provided with a take-home supply of nasal naloxone for ongoing support.