Skip to main content
HCPCS G0118 · Level II · G code

G0118: Glaucoma scrn hgh risk direc, 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); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 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; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for G0118

Medicare payment
$40.42
PFS non-facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
42
39 hospital outpatient
LCDs and articles
0 / 1

TL;DR

HCPCS Level II G0118 reads "Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist" in the October 2026 file; it dates from 2002. National PFS payment for G0118 is $40.42 in an office and no facility amount in a facility (October 2026), built from 0.17 work, 1.03 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $40.62 at $33.5675. CMS caps G0118 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0118 appears in 39 practitioner pairs as column 2 and 3 as column 1 (most often with 0329T, 92002, 92004), and in 39 hospital outpatient pairs as column 2 and 0 as column 1. 1 billing and coding article lists G0118 across 7 states: A53495. HCPCS record: BETOS T2D (other tests - other); pricing indicator 11; type of service Q (vision items or services). Nearby codes: G0117, G0121, G0123, G0124.

G0118 descriptor and code status

The October 2026 HCPCS Level II file describes G0118 as “Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0118
FieldValue
Short descriptorGlaucoma scrn hgh risk direc
Added to HCPCS2002-01-01
Last actionN (no maintenance), effective 2002-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryT2D: other tests - other
Type of serviceQ: vision items or services

Medicare payment for G0118

National PFS payment for G0118 is $40.42 in an office and no facility amount in a facility (October 2026), built from 0.17 work, 1.03 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $40.62 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 T: injection: paid only when no other fee schedule service is billed that day by the same provider. 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 G0118
ComponentNon-facilityFacility
Work RVU0.170.17
Practice expense RVU1.03NA
Malpractice RVU0.010.01
Total RVUs1.21NA
National payment (CF $33.4009)$40.42n/a
Qualifying APM participant (CF $33.5675)$40.62n/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 S (Procedure or service, not discounted when multiple), APC 5732 (Level 2 Minor Procedures), national unadjusted payment $38.16 with a minimum unadjusted copayment of $7.64.

Medically Unlikely Edits for G0118

CMS caps G0118 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0118 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for G0118 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0118 is the column-2 (bundled) code in 39 active pairs, 5% of which allow a modifier and the column-1 code in 3 (0% modifier-allowed); 75 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Standards of medical/surgical practice.

Column-1 codes most often paired with G0118 (practitioner)
Column-1 codePairs
0329T (CPT; descriptor licensed by AMA)1
92002 (CPT; descriptor licensed by AMA)1
92004 (CPT; descriptor licensed by AMA)1
92012 (CPT; descriptor licensed by AMA)1
92014 (CPT; descriptor licensed by AMA)1
92100 (CPT; descriptor licensed by AMA)1
92137 (CPT; descriptor licensed by AMA)1
92145 (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into G0118 (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

In the hospital outpatient PTP file v323r0, G0118 is the column-2 (bundled) code in 39 active pairs, 90% of which allow a modifier and the column-1 code in 0; 59 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Standards of medical/surgical practice.

Column-1 codes most often paired with G0118 (hospital outpatient)
Column-1 codePairs
0329T (CPT; descriptor licensed by AMA)1
92002 (CPT; descriptor licensed by AMA)1
92004 (CPT; descriptor licensed by AMA)1
92012 (CPT; descriptor licensed by AMA)1
92014 (CPT; descriptor licensed by AMA)1
92100 (CPT; descriptor licensed by AMA)1
92137 (CPT; descriptor licensed by AMA)1
92145 (CPT; descriptor licensed by AMA)1

G0118 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 G0118 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0118

0 active Local Coverage Determinations and 1 billing and coding article list G0118. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing G0118
ArticleTitleContractor(s)Related LCD
A53495Glaucoma ScreeningPalmetto GBA—

Denials to expect on G0118

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0118

CARC 151 · N362

units of G0118 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 information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0118 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0118 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 G0118

What does HCPCS code G0118 describe?

"Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist" (short descriptor "Glaucoma scrn hgh risk direc"), in the G section (procedures and professional services, temporary). Added 2002-01-01.

Is G0118 a CPT code?

It is not. G0118 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for G0118?

National PFS payment for G0118 is $40.42 in an office and no facility amount in a facility (October 2026), built from 0.17 work, 1.03 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $40.62 at $33.5675.

How many units of G0118 can be billed per day?

CMS caps G0118 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0118?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 billing and coding article lists G0118 across 7 states: A53495.

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.