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HCPCS
G0137

HCPCS Code G0137

Official Description

Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include

  • individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law);
  • occupational therapy requiring the skills of a qualified occupational therapist;
  • services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients;
  • individualized activity therapies that are not primarily recreational or diversionary;
  • family counseling (the primary purpose of which is treatment of the individual's condition);
  • patient training and education (to the extent that training and educational activities are closely and clearly related to individual's care and treatment);
  • diagnostic services;
  • and such other items and services (excluding meals and transportation) that are reasonable and necessary for the diagnosis or active treatment of the individual's condition, reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services in accordance with a physician certification and plan of treatment (provision of the services by a medicare-enrolled opioid treatment program);
list separately in addition to code for primary procedure
Short Descr Inten outpt svs,min 9 pr 7 d
Coverage Carrier Priced
Pricing Indicator(s) 13 – Physician Fee Schedule - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion)
MPI A – Not applicable, as HCPCS priced under one methodology
BETOS M5D – Specialist - other
TOS Code(s) 1 – Medical care
Added Date 1/1/2024
Status Code Statutory Exclusion (from MPFS, may be paid under other methodologies)
Global Days ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC) 9 - Not Applicable
Multiple Procedures (51) 9 - Concept does not apply.
Bilateral Surgery (50) 9 - Concept does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 9 - Concept does not apply.
Co-Surgeons (62) 9 - Concept does not apply.
Team Surgery (66) 9 - Concept does not apply.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Service Paid under Fee Schedule or Payment System other than OPPS
MUE 1
MUE Not applicable/unspecified.
OTS Orthotic No
95 Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
Date
Action
Notes
2024-01-01 Added Code added.
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