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HCPCS G0162 · Level II · G code

G0162: Skilled services by a RN for management and evaluation of the plan of care, 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 G0162

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
14
11 hospital outpatient
LCDs and articles
0 / 0

TL;DR

CMS describes HCPCS G0162, added in 2011, as "Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)". The physician fee schedule lists G0162 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 G0162 appears in 0 practitioner pairs as column 2 and 14 as column 1, and in 0 hospital outpatient pairs as column 2 and 11 as column 1. No current LCD or billing article lists G0162; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). 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: G0160, G0159, G0158, G0166.

G0162 descriptor and code status

The October 2026 HCPCS Level II file describes G0162 as “Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0162
FieldValue
Short descriptorHhc rn e&m plan svs, 15 min
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 G0162

The physician fee schedule lists G0162 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 G0162

CMS publishes no MUE for G0162 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 G0162 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0162 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 14 (79% modifier-allowed); 0 earlier pairs have been deleted.

Column-2 codes bundled into G0162 (practitioner)
Column-2 codePairs
36000 (CPT; descriptor licensed by AMA)1
36410 (CPT; descriptor licensed by AMA)1
36430 (CPT; descriptor licensed by AMA)1
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1
96360 (CPT; descriptor licensed by AMA)1
96365 (CPT; descriptor licensed by AMA)1
96523 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0162 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 11 (100% modifier-allowed); 0 earlier pairs have been deleted.

Column-2 codes bundled into G0162 (hospital outpatient)
Column-2 codePairs
36000 (CPT; descriptor licensed by AMA)1
36410 (CPT; descriptor licensed by AMA)1
36430 (CPT; descriptor licensed by AMA)1
96360 (CPT; descriptor licensed by AMA)1
96365 (CPT; descriptor licensed by AMA)1
G0008 Admin influenza virus vac1
G0009 Admin pneumococcal vaccine1
G0010 Admin hepatitis b vaccine1

G0162 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 G0162 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0162

No current LCD or billing and coding article lists G0162. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on G0162

CARC 50 · N115

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

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 G0162 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0162 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 G0162

What does HCPCS code G0162 describe?

"Skilled services by a registered nurse (rn) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an rn to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting)" (short descriptor "Hhc rn e&m plan svs, 15 min"), in the G section (procedures and professional services, temporary). Added 2011-01-01.

Is G0162 a CPT code?

No: CMS maintains G0162 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for G0162?

The physician fee schedule lists G0162 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.

Does Medicare cover G0162?

No current LCD or billing article lists G0162; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

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.