what is condition code g0

What is Condition Code G0?

Usage of Condition code G0 in the Hospital Outpatient Prospective Payment System (OPPS) indicates that the visits were distinct and independent of each other and, therefore, qualify for separate reimbursement for each visit. 

Modifier 27 would be appended to the appropriate level of E/M codes.

How To Report Condition Code G0

The condition code G0 must appear in form locator 24-30 on Hospital OPPS claims to prevent a rejection as a duplicate claim when Multiple medical visits (based on units and/or lines) are present on the same day with the same revenue code.

Hospital clinics that generate bills only for their individual services must be aware of services provided to Medicare patients at other outpatient clinics within the same facility.

Third-party payers should then look for the presence of the modifier 27 and the G0 condition code to prevent denials of multiple unrelated medical visits on the same day.

Example Of Condition Code G0

If the CPT codes are identical and the revenue code is the same, the hospital would bill both services with modifier 27 appended, on a single claim on separate line items or a value of two (or more) units on one line.

Report the G0 condition code to indicate that the hospital is aware it is indeed billing more than one clinic visit on the same day and that those visits are unrelated and, therefore, qualify for separate reimbursement for each visit.

Reference for condition code G0: https://www.cms.gov/transmittals/downloads/R270CP.pdf

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