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HCPCS G0238 · Level II · G code

G0238: Therapeutic procedures to improve respiratory function, other than described by g0237, 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 G0238

Medicare payment
$11.36
PFS non-facility, national
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
8
MAI 3
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
42
39 hospital outpatient
LCDs and articles
2 / 3

TL;DR

G0238 is a Level II code from the G section (procedures and professional services, temporary), in use since 2002: "Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)". National PFS payment for G0238 is $11.36 in an office and no facility amount in a facility (October 2026), built from 0.00 work, 0.33 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $11.41 at $33.5675. CMS caps G0238 at practitioner 8 (MAI 3, Clinical: Data); hospital outpatient 8 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0238 appears in 1 practitioner pairs as column 2 and 41 as column 1 (most often with G0239), and in 1 hospital outpatient pairs as column 2 and 38 as column 1. 2 active LCDs and 3 billing and coding articles list G0238 across 13 states: L34149 (Respiratory Care), L34430 (Respiratory Therapy (Respiratory Care)), A56152, A56717. HCPCS record: BETOS P6C (minor procedures - other (Medicare fee schedule)); pricing indicator 11; type of service 1 (medical care), U (occupational therapy), W (physical therapy). Nearby codes: G0237, G0239, G0245, G0246.

G0238 descriptor and code status

The October 2026 HCPCS Level II file describes G0238 as “Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0238 CPT code", G0238 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 G0238
FieldValue
Short descriptorOth resp proc, indiv
Added to HCPCS2002-01-01
Last actionN (no maintenance), effective 2004-10-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator11: physician fee schedule, priced with national RVUs
BETOS categoryP6C: minor procedures - other (Medicare fee schedule)
Type of service1: medical care; U: occupational therapy; W: physical therapy

Medicare payment for G0238

National PFS payment for G0238 is $11.36 in an office and no facility amount in a facility (October 2026), built from 0.00 work, 0.33 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $11.41 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 A: active: paid separately under the physician fee schedule when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 5 (incident-to service).

PFS relative values and national payment for G0238
ComponentNon-facilityFacility
Work RVU0.000.00
Practice expense RVU0.33NA
Malpractice RVU0.010.01
Total RVUs0.34NA
National payment (CF $33.4009)$11.36n/a
Qualifying APM participant (CF $33.5675)$11.41n/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 5731 (Level 1 Minor Procedures), national unadjusted payment $29.55 with a minimum unadjusted copayment of $5.91.

Medically Unlikely Edits for G0238

CMS caps G0238 at practitioner 8 (MAI 3, Clinical: Data); hospital outpatient 8 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for G0238 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services83 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital83 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for G0238 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0238 is the column-2 (bundled) code in 1 active pair, 100% of which allow a modifier and the column-1 code in 41 (73% modifier-allowed); 31 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: More extensive procedure.

Column-1 codes most often paired with G0238 (practitioner)
Column-1 codePairs
G0239 Oth resp proc, group1
Column-2 codes bundled into G0238 (practitioner)
Column-2 codePairs
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1
94010 (CPT; descriptor licensed by AMA)1
94060 (CPT; descriptor licensed by AMA)1
94150 (CPT; descriptor licensed by AMA)1
94200 (CPT; descriptor licensed by AMA)1
94375 (CPT; descriptor licensed by AMA)1
94450 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0238 is the column-2 (bundled) code in 1 active pair, 100% of which allow a modifier and the column-1 code in 38 (87% modifier-allowed); 31 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: More extensive procedure.

Column-1 codes most often paired with G0238 (hospital outpatient)
Column-1 codePairs
G0239 Oth resp proc, group1
Column-2 codes bundled into G0238 (hospital outpatient)
Column-2 codePairs
94010 (CPT; descriptor licensed by AMA)1
94060 (CPT; descriptor licensed by AMA)1
94150 (CPT; descriptor licensed by AMA)1
94200 (CPT; descriptor licensed by AMA)1
94375 (CPT; descriptor licensed by AMA)1
94450 (CPT; descriptor licensed by AMA)1
94617 (CPT; descriptor licensed by AMA)1
94618 (CPT; descriptor licensed by AMA)1

G0238 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 G0238 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0238

2 active Local Coverage Determinations and 3 billing and coding articles list G0238. 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 G0238
ArticleTitleContractor(s)Related LCD
A56152Billing and Coding: Pulmonary Rehabilitation ServicesNoridian Healthcare Solutions, LLC—
A56717Billing and Coding: Respiratory Therapy (Respiratory Care)Palmetto GBAL34430
A57224Billing and Coding: Respiratory CareNoridian Healthcare Solutions, LLCL34149, L39604

Denials to expect on G0238

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0238

CARC 151 · N362

units of G0238 exceed the practitioner MUE of 8 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 G0238 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0238 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 G0238

What does HCPCS code G0238 describe?

"Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)" (short descriptor "Oth resp proc, indiv"), in the G section (procedures and professional services, temporary). Added 2002-01-01; last action N (no maintenance) effective 2004-10-01.

Is G0238 a CPT code?

It is not. G0238 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT. "G0238 CPT code" searches refer to it.

What does Medicare pay for G0238?

National PFS payment for G0238 is $11.36 in an office and no facility amount in a facility (October 2026), built from 0.00 work, 0.33 practice-expense and 0.01 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $11.41 at $33.5675.

How many units of G0238 can be billed per day?

CMS caps G0238 at practitioner 8 (MAI 3, Clinical: Data); hospital outpatient 8 (MAI 3, Clinical: Data) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 8 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0238?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 2 active LCDs and 3 billing and coding articles list G0238 across 13 states: L34149 (Respiratory Care), L34430 (Respiratory Therapy (Respiratory Care)), A56152, A56717.

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.