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HCPCS G0160 · Level II · G code

G0160: Services performed by a qualified occupational therapist, in the home health setting, 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 G0160

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
OPPS status
SI B
Non-allowed item or service for OPPS
NCCI PTP pairs
18
15 hospital outpatient
LCDs and articles
1 / 1

TL;DR

G0160 is a Level II code from the G section (procedures and professional services, temporary), in use since 2011: "Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes". The physician fee schedule lists G0160 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 G0160 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 G0160 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: G0159, G0158, G0157, G0156.

G0160 descriptor and code status

The October 2026 HCPCS Level II file describes G0160 as “Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, 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 "G0160 CPT code", G0160 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 G0160
FieldValue
Short descriptorHhc occup therapy ea 15
Added to HCPCS2011-01-01
Last actionN (no maintenance), effective 2011-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator00: not separately priced by Part B
BETOS categoryY2: other - non-Medicare fee schedule
Type of service1: medical care

Medicare payment for G0160

The physician fee schedule lists G0160 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 G0160

CMS publishes no MUE for G0160 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 G0160 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0160 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 18 (61% modifier-allowed); 19 earlier pairs have been deleted.

Column-2 codes bundled into G0160 (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
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, G0160 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 15 (73% modifier-allowed); 19 earlier pairs have been deleted.

Column-2 codes bundled into G0160 (hospital outpatient)
Column-2 codePairs
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

G0160 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 G0160 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0160

1 active Local Coverage Determination and 1 billing and coding article list G0160. 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 G0160
ArticleTitleContractor(s)Related LCD
A53057Billing and Coding: Home Health Occupational TherapyPalmetto GBAL34560

Denials to expect on G0160

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0160

CARC 151 · N362

units exceed what the payer considers medically likely for one 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 G0160 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0160 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 G0160

What does HCPCS code G0160 describe?

"Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 15 minutes" (short descriptor "Hhc occup therapy ea 15"), in the G section (procedures and professional services, temporary). Added 2011-01-01.

Is G0160 a CPT code?

It is not. G0160 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT. "G0160 CPT code" searches refer to it.

What does Medicare pay for G0160?

The physician fee schedule lists G0160 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.

Does Medicare cover G0160?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD and 1 billing and coding article list G0160 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.

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.