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HCPCS G0109 · Level II · G code

G0109: Diabetes outpatient self-management training services, group session (2 or more), 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 G0109

Medicare payment
$16.03
PFS non-facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
12
MAI 3
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
8
5 hospital outpatient
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

HCPCS Level II G0109 reads "Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes" in the October 2026 file; it dates from 1998. National PFS payment for G0109 is $16.03 in an office and no facility amount in a facility (October 2026), built from 0.25 work, 0.22 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $16.11 at $33.5675. CMS caps G0109 at practitioner 12 (MAI 3, Nature of Service/Procedure); hospital outpatient 12 (MAI 3, Nature of Service/Procedure) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0109 appears in 0 practitioner pairs as column 2 and 8 as column 1, and in 0 hospital outpatient pairs as column 2 and 5 as column 1. G0109 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. It is on the CY2026 Medicare telehealth list (CMS action: Maintain). OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS Y1 (other - Medicare fee schedule); pricing indicator 11; type of service 1 (medical care). 1 other active code opens with "Diabetes outpatient self-management training services"; related codes: G0108, G0105, G0104, G0103.

G0109 descriptor and code status

The October 2026 HCPCS Level II file describes G0109 as “Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0109 CPT code", G0109 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0109
FieldValue
Short descriptorDiab manage trn ind/group
Added to HCPCS1998-07-01
Last actionN (no maintenance), effective 2001-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryY1: other - Medicare fee schedule
Type of service1: medical care

Medicare payment for G0109

National PFS payment for G0109 is $16.03 in an office and no facility amount in a facility (October 2026), built from 0.25 work, 0.22 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $16.11 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 G0109
ComponentNon-facilityFacility
Work RVU0.250.25
Practice expense RVU0.22NA
Malpractice RVU0.010.01
Total RVUs0.48NA
National payment (CF $33.4009)$16.03n/a
Qualifying APM participant (CF $33.5675)$16.11n/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 A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.

Medically Unlikely Edits for G0109

CMS caps G0109 at practitioner 12 (MAI 3, Nature of Service/Procedure); hospital outpatient 12 (MAI 3, Nature of Service/Procedure) units per day in the 2026 Q4 MUE tables. 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 G0109 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services123 Date of Service Edit: ClinicalNature of Service/Procedure
Facility outpatient hospital123 Date of Service Edit: ClinicalNature of Service/Procedure

The MUE lookup for G0109 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0109 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 8 (0% modifier-allowed); 74 earlier pairs have been deleted.

Column-2 codes bundled into G0109 (practitioner)
Column-2 codePairs
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1
96523 (CPT; descriptor licensed by AMA)1
97802 (CPT; descriptor licensed by AMA)1
97803 (CPT; descriptor licensed by AMA)1
97804 (CPT; descriptor licensed by AMA)1
G0270 Mnt subs tx for change dx1
G0271 Group mnt 2 or more 30 mins1

In the hospital outpatient PTP file v323r0, G0109 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 5 (0% modifier-allowed); 5 earlier pairs have been deleted.

Column-2 codes bundled into G0109 (hospital outpatient)
Column-2 codePairs
97802 (CPT; descriptor licensed by AMA)1
97803 (CPT; descriptor licensed by AMA)1
97804 (CPT; descriptor licensed by AMA)1
G0270 Mnt subs tx for change dx1
G0271 Group mnt 2 or more 30 mins1

G0109 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 G0109 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0109

No current LCD or billing and coding article lists G0109. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Telehealth status

G0109 is on the CY2026 Medicare telehealth services list (CMS action: Maintain). Bill it with the place-of-service code and modifiers that match where the patient and the practitioner are on the date of service.

Denials to expect on G0109

CARC 50 · N115

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

CARC 151 · N362

units of G0109 exceed the practitioner MUE of 12 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0109 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0109 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 G0109

What does HCPCS code G0109 describe?

"Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes" (short descriptor "Diab manage trn ind/group"), in the G section (procedures and professional services, temporary). Added 1998-07-01; last action N (no maintenance) effective 2001-01-01.

Is G0109 a CPT code?

It is not. G0109 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT. "G0109 CPT code" searches refer to it.

What does Medicare pay for G0109?

National PFS payment for G0109 is $16.03 in an office and no facility amount in a facility (October 2026), built from 0.25 work, 0.22 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $16.11 at $33.5675.

How many units of G0109 can be billed per day?

CMS caps G0109 at practitioner 12 (MAI 3, Nature of Service/Procedure); hospital outpatient 12 (MAI 3, Nature of Service/Procedure) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 12 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0109?

G0109 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.

Can G0109 be billed as telehealth?

Yes. G0109 is on the CY2026 Medicare telehealth list (Maintain); the place-of-service and modifier rules on the date of service still apply.

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.