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HCPCS G0137 · Level II · G code

G0137: Intensive outpatient services; weekly bundle, 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 G0137

Medicare payment
no PFS amount
PFS status X; OPPS SI A: paid under another fee schedule or system
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI A
Services not paid under OPPS; paid under fee schedule or other payment system
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 1
add-on code

TL;DR

HCPCS Level II G0137 reads "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" in the October 2026 file; it dates from 2024. The physician fee schedule lists G0137 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays G0137 under a fee schedule or payment system other than OPPS. Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). G0137 is an add-on code (NCCI edit type 2): Medicare pays it only on a claim that also carries a contractor-defined primary code. 1 active LCD and 1 billing and coding article list G0137 across 4 states: L39849 (Opioid Treatment Programs), A59718. HCPCS record: BETOS M5D (specialist - other); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0136, G0138, G0140, G0141.

G0137 descriptor and code status

The October 2026 HCPCS Level II file describes G0137 as “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”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0137
FieldValue
Short descriptorInten outpt svs,min 9 pr 7 d
Added to HCPCS2024-01-01
Last actionN (no maintenance), effective 2024-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryM5D: specialist - other
Type of service1: medical care

Medicare payment for G0137

The physician fee schedule lists G0137 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays G0137 under a fee schedule or payment system other than OPPS. 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 X: statutory exclusion: not a physician service under the fee schedule. Global period ZZZ (add-on service inside the primary service's global period); PC/TC indicator 9 (professional/technical 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 G0137

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). 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 G0137 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 G0137 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0137 in v323r0.

G0137 is an add-on code: it is payable only with a primary service on the same claim defined by the contractor. CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check G0137 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0137

1 active Local Coverage Determination and 1 billing and coding article list G0137. 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 G0137
ArticleTitleContractor(s)Related LCD
A59718Billing and Coding: Opioid Treatment ProgramsPalmetto GBAL39849

Denials to expect on G0137

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0137

CARC 151 · N362

units of G0137 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 G0137 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0137 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 G0137

What does HCPCS code G0137 describe?

"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 descriptor "Inten outpt svs,min 9 pr 7 d"), in the G section (procedures and professional services, temporary). Added 2024-01-01.

Is G0137 a CPT code?

No. G0137 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for G0137?

The physician fee schedule lists G0137 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. Its OPPS status indicator is A, which the I/OCE table defines as "Services not paid under OPPS; paid under fee schedule or other payment system": Medicare pays G0137 under a fee schedule or payment system other than OPPS.

Is G0137 an add-on code?

G0137 is an add-on code (NCCI edit type 2): Medicare pays it only on a claim that also carries a contractor-defined primary code.

How many units of G0137 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). 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 G0137?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD and 1 billing and coding article list G0137 across 4 states: L39849 (Opioid Treatment Programs), A59718.

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.