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HCPCS G0080 · Level II · G code

G0080: Care manag h vst new pt 75 m, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G0080

Medicare payment
$217.11
PFS non-facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 3
OPPS status
SI B
Non-allowed item or service for OPPS
NCCI PTP pairs
12
12 hospital outpatient
LCDs and articles
0 / 0

TL;DR

HCPCS Level II G0080 reads "Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)" in the October 2026 file; it dates from 2019. Medicare's October 2026 physician fee schedule pays G0080 $217.11 non-facility and no facility amount facility nationally, from 4.09 work, 2.16 practice-expense and 0.25 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $218.19 at $33.5675. MUE limits for G0080: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). In the NCCI PTP files v323r0 G0080 appears in 12 practitioner pairs as column 2 and 0 as column 1 (most often with G2001, G2002, G2003), and in 12 hospital outpatient pairs as column 2 and 0 as column 1. G0080 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. OPPS status indicator B: Non-allowed item or service for OPPS. HCPCS record: BETOS M4A (home visit); pricing indicator 13; type of service 1 (medical care). 3 other active codes open with "Extensive"; related codes: G2005, G0085, G2013, G0101.

G0080 descriptor and code status

The October 2026 HCPCS Level II file describes G0080 as “Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0080
FieldValue
Short descriptorCare manag h vst new pt 75 m
Added to HCPCS2019-01-01
Last actionN (no maintenance), effective 2019-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryM4A: home visit
Type of service1: medical care

Medicare payment for G0080

Medicare's October 2026 physician fee schedule pays G0080 $217.11 non-facility and no facility amount facility nationally, from 4.09 work, 2.16 practice-expense and 0.25 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $218.19 at $33.5675. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status A: active: paid separately under the physician fee schedule when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0080
ComponentNon-facilityFacility
Work RVU4.094.09
Practice expense RVU2.16NA
Malpractice RVU0.250.25
Total RVUs6.50NA
National payment (CF $33.4009)$217.11n/a
Qualifying APM participant (CF $33.5675)$218.19n/a
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery paid only with documentation; co-surgeons: co-surgeons not permitted; team surgery: team surgeons not permitted
  • Physician supervision of diagnostic procedures: supervision concept does not apply

Hospital outpatient (OPPS Addendum B)

Status indicator B (Non-allowed item or service for OPPS), with no separate OPPS payment rate.

Medically Unlikely Edits for G0080

MUE limits for G0080: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for G0080 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalNature of Service/Procedure
Facility outpatient hospital13 Date of Service Edit: ClinicalNature of Service/Procedure

The MUE lookup for G0080 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0080 is the column-2 (bundled) code in 12 active pairs, 0% of which allow a modifier and the column-1 code in 0; 82 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.

Column-1 codes most often paired with G0080 (practitioner)
Column-1 codePairs
G2001 Post d/c h vst new pt 20 m1
G2002 Post-d/c h vst new pt 30 m1
G2003 Post-d/c h vst new pt 45 m1
G2004 Post-d/c h vst new pt 60 m1
G2005 Post-d/c h vst new pt 75 m1
G2006 Post-d/c h vst ext pt 20 m1
G2007 Post-d/c h vst ext pt 30 m1
G2008 Post-d/c h vst ext pt 45 m1

In the hospital outpatient PTP file v323r0, G0080 is the column-2 (bundled) code in 12 active pairs, 0% of which allow a modifier and the column-1 code in 0; 15 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.

Column-1 codes most often paired with G0080 (hospital outpatient)
Column-1 codePairs
G2001 Post d/c h vst new pt 20 m1
G2002 Post-d/c h vst new pt 30 m1
G2003 Post-d/c h vst new pt 45 m1
G2004 Post-d/c h vst new pt 60 m1
G2005 Post-d/c h vst new pt 75 m1
G2006 Post-d/c h vst ext pt 20 m1
G2007 Post-d/c h vst ext pt 30 m1
G2008 Post-d/c h vst ext pt 45 m1

G0080 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check G0080 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0080

No current LCD or billing and coding article lists G0080. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on G0080

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of G0080 exceed the practitioner MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for G0080 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0080 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0080

What does HCPCS code G0080 describe?

"Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)" (short descriptor "Care manag h vst new pt 75 m"), in the G section (procedures and professional services, temporary). Added 2019-01-01.

Is G0080 a CPT code?

No: CMS maintains G0080 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for G0080?

Medicare's October 2026 physician fee schedule pays G0080 $217.11 non-facility and no facility amount facility nationally, from 4.09 work, 2.16 practice-expense and 0.25 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $218.19 at $33.5675.

How many units of G0080 can be billed per day?

MUE limits for G0080: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). For the practitioner MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0080?

G0080 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.