Key facts for G0158
- Medicare payment
- no PFS amount
- PFS status E
- Coverage code
- C
- carrier judgment, so the Medicare contractor decides coverage
- MUE
- none published
- no MUE in the 2026 Q4 tables
- NCCI PTP pairs
- 18
- 15 hospital outpatient
- LCDs and articles
- 1 / 1
TL;DR
HCPCS Level II G0158 reads "Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes" in the October 2026 file; it dates from 2011. The physician fee schedule lists G0158 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. In the NCCI PTP files v323r0 G0158 appears in 0 practitioner pairs as column 2 and 18 as column 1, and in 0 hospital outpatient pairs as column 2 and 15 as column 1. 1 active LCD and 1 billing and coding article list G0158 across 16 states: L34560 (Home Health Occupational Therapy), A53057. OPPS status indicator B: Non-allowed item or service for OPPS. HCPCS record: BETOS Y2 (other - non-Medicare fee schedule); pricing indicator 00; type of service 1 (medical care). Nearby codes: G0157, G0159, G0156, G0160.
G0158 descriptor and code status
The October 2026 HCPCS Level II file describes G0158 as “Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0158 CPT code", G0158 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.
| Field | Value |
|---|---|
| Short descriptor | Hhc ot assistant ea 15 |
| Added to HCPCS | 2011-01-01 |
| Last action | N (no maintenance), effective 2011-01-01 |
| Coverage code | C: carrier judgment, so the Medicare contractor decides coverage |
| Pricing indicator | 00: not separately priced by Part B |
| BETOS category | Y2: other - non-Medicare fee schedule |
| Type of service | 1: medical care |
Medicare payment for G0158
The physician fee schedule lists G0158 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. 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 E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical 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 G0158
CMS publishes no MUE for G0158 in the 2026 Q4 practitioner, facility or DME supplier tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the quantity furnished on every claim.
The MUE lookup for G0158 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, G0158 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 18 (61% modifier-allowed); 18 earlier pairs have been deleted.
| Column-2 code | Pairs |
|---|---|
| 36591 (CPT; descriptor licensed by AMA) | 1 |
| 36592 (CPT; descriptor licensed by AMA) | 1 |
| 96523 (CPT; descriptor licensed by AMA) | 1 |
| 97150 (CPT; descriptor licensed by AMA) | 1 |
| 97161 (CPT; descriptor licensed by AMA) | 1 |
| 97162 (CPT; descriptor licensed by AMA) | 1 |
| 97163 (CPT; descriptor licensed by AMA) | 1 |
| 97164 (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, G0158 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 15 (73% modifier-allowed); 18 earlier pairs have been deleted.
| Column-2 code | Pairs |
|---|---|
| 97150 (CPT; descriptor licensed by AMA) | 1 |
| 97161 (CPT; descriptor licensed by AMA) | 1 |
| 97162 (CPT; descriptor licensed by AMA) | 1 |
| 97163 (CPT; descriptor licensed by AMA) | 1 |
| 97164 (CPT; descriptor licensed by AMA) | 1 |
| 97165 (CPT; descriptor licensed by AMA) | 1 |
| 97166 (CPT; descriptor licensed by AMA) | 1 |
| 97167 (CPT; descriptor licensed by AMA) | 1 |
G0158 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 G0158 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for G0158
1 active Local Coverage Determination and 1 billing and coding article list G0158. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.
- LCD L34560: Home Health Occupational Therapy · Palmetto GBA
| Article | Title | Contractor(s) | Related LCD |
|---|---|---|---|
| A53057 | Billing and Coding: Home Health Occupational Therapy | Palmetto GBA | L34560 |
Denials to expect on G0158
the diagnosis or documentation does not meet the LCD or billing article that lists G0158
the modifier reported is inconsistent with the code
the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier
Where QuickIntell fits for G0158 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0158 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.
Frequently asked questions: HCPCS G0158
What does HCPCS code G0158 describe?
"Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 15 minutes" (short descriptor "Hhc ot assistant ea 15"), in the G section (procedures and professional services, temporary). Added 2011-01-01.
Is G0158 a CPT code?
No. G0158 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0158 CPT code" mean this Level II code.
What does Medicare pay for G0158?
The physician fee schedule lists G0158 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.
Does Medicare cover G0158?
Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD and 1 billing and coding article list G0158 across 16 states: L34560 (Home Health Occupational Therapy), A53057.
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.
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
- Medicare PFS national relative value file RVU26D (non-QPP), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_nonQPP.csvSHA-256 4d0d3f19bd954ffc…
- Medicare PFS national relative value file RVU26D (qualifying APM participants), October 2026Version RVU26D, released 2026-08-26 · effective 2026-10-01 · file PPRRVU2026_Oct_QPP.csvSHA-256 59d3734704853936…
- OPPS Addendum B, October 2026Version October 2026 · effective 2026-10-01 · file 508-compliant-version-2026_October_Web_Addendum_B.09.28.26.csvSHA-256 6ad7393a318bf1b9…
- Integrated Outpatient Code Editor v27.3 data tables: status and payment indicatorsVersion I/OCE v27.3 (October 2026) · effective 2026-10-01 · file Data_Status_Indicator.txtSHA-256 78f119ef0a435351…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
- NCCI PTP edits, hospital outpatient, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccioph-v323r0-f1.txtSHA-256 063f41b91ef9faa2…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file article.csvSHA-256 5e95c4a8ac3664be…
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file lcd.csvSHA-256 9aee1bd7f14056b0…
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.