Key facts for G0245
- Medicare payment
- $65.47
- PFS non-facility, national; facility $34.74
- Coverage code
- D
- special coverage instructions apply
- Practitioner MUE
- 1
- MAI 2
- NCCI PTP pairs
- 105
- 88 hospital outpatient
- LCDs and articles
- 0 / 0
TL;DR
HCPCS Level II G0245 reads "Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education" in the October 2026 file; it dates from 2002. Under the 2026 physician fee schedule (October release) G0245 carries 0.86 work, 1.06 practice-expense and 0.04 malpractice RVUs, which at $33.4009 per RVU pays $65.47 non-facility and $34.74 facility before the locality adjustment. Qualifying APM participants get $65.79 at $33.5675. 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). G0245 is a primary code for 1 add-on code (G0247). In the NCCI PTP files v323r0 G0245 appears in 63 practitioner pairs as column 2 and 42 as column 1 (most often with 99202, 99203, 99204), and in 55 hospital outpatient pairs as column 2 and 33 as column 1. No current LCD or billing article lists G0245; its HCPCS coverage code is D (special coverage instructions apply). HCPCS record: BETOS M1A (office visits - new); pricing indicator 11; type of service 1 (medical care). Nearby codes: G0246, G0247, G0248, G0249.
G0245 descriptor and code status
The October 2026 HCPCS Level II file describes G0245 as “Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0245 CPT code", G0245 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 | Initial foot exam pt lops |
| Added to HCPCS | 2002-07-01 |
| Last action | N (no maintenance), effective 2002-07-01 |
| Coverage code | D: special coverage instructions apply |
| Pricing indicator | 11: physician fee schedule, priced with national RVUs |
| BETOS category | M1A: office visits - new |
| Type of service | 1: medical care |
Medicare payment for G0245
Under the 2026 physician fee schedule (October release) G0245 carries 0.86 work, 1.06 practice-expense and 0.04 malpractice RVUs, which at $33.4009 per RVU pays $65.47 non-facility and $34.74 facility before the locality adjustment. Qualifying APM participants get $65.79 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 R: restricted coverage: contractor-priced when covered. Global period XXX (global surgery concept does not apply); PC/TC indicator 0 (physician service; the professional/technical split does not apply).
| Component | Non-facility | Facility |
|---|---|---|
| Work RVU | 0.86 | 0.86 |
| Practice expense RVU | 1.06 | 0.14 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVUs | 1.96 | 1.04 |
| National payment (CF $33.4009) | $65.47 | $34.74 |
| Qualifying APM participant (CF $33.5675) | $65.79 | $34.91 |
- 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 V (Clinic or emergency department visit), APC 5012 (Clinic Visits and Related Services), national unadjusted payment $136.02 with a minimum unadjusted copayment of $27.21.
Medically Unlikely Edits for G0245
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.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
| Facility outpatient hospital | 1 | 2 Date of Service Edit: Policy | Code Descriptor / CPT Instruction |
The MUE lookup for G0245 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, G0245 is the column-2 (bundled) code in 63 active pairs, 8% of which allow a modifier and the column-1 code in 42 (17% modifier-allowed); 125 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Standards of medical/surgical practice.
| Column-1 code | Pairs |
|---|---|
| 99202 (CPT; descriptor licensed by AMA) | 1 |
| 99203 (CPT; descriptor licensed by AMA) | 1 |
| 99204 (CPT; descriptor licensed by AMA) | 1 |
| 99205 (CPT; descriptor licensed by AMA) | 1 |
| 99211 (CPT; descriptor licensed by AMA) | 1 |
| 99212 (CPT; descriptor licensed by AMA) | 1 |
| 99213 (CPT; descriptor licensed by AMA) | 1 |
| 99214 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 0552T (CPT; descriptor licensed by AMA) | 1 |
| 0936T (CPT; descriptor licensed by AMA) | 1 |
| 11042 (CPT; descriptor licensed by AMA) | 1 |
| 11043 (CPT; descriptor licensed by AMA) | 1 |
| 11044 (CPT; descriptor licensed by AMA) | 1 |
| 11055 (CPT; descriptor licensed by AMA) | 1 |
| 11056 (CPT; descriptor licensed by AMA) | 1 |
| 11057 (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, G0245 is the column-2 (bundled) code in 55 active pairs, 98% of which allow a modifier and the column-1 code in 33 (42% modifier-allowed); 98 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Standards of medical/surgical practice.
| Column-1 code | Pairs |
|---|---|
| 99202 (CPT; descriptor licensed by AMA) | 1 |
| 99203 (CPT; descriptor licensed by AMA) | 1 |
| 99204 (CPT; descriptor licensed by AMA) | 1 |
| 99205 (CPT; descriptor licensed by AMA) | 1 |
| 99211 (CPT; descriptor licensed by AMA) | 1 |
| 99212 (CPT; descriptor licensed by AMA) | 1 |
| 99213 (CPT; descriptor licensed by AMA) | 1 |
| 99214 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 0552T (CPT; descriptor licensed by AMA) | 1 |
| 0936T (CPT; descriptor licensed by AMA) | 1 |
| 11042 (CPT; descriptor licensed by AMA) | 1 |
| 11043 (CPT; descriptor licensed by AMA) | 1 |
| 11044 (CPT; descriptor licensed by AMA) | 1 |
| 11055 (CPT; descriptor licensed by AMA) | 1 |
| 11056 (CPT; descriptor licensed by AMA) | 1 |
| 11057 (CPT; descriptor licensed by AMA) | 1 |
G0245 is a designated primary code for 1 add-on code (G0247).
Pair counts show exposure, not the answer for one claim. Check G0245 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for G0245
No current LCD or billing and coding article lists G0245. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.
Denials to expect on G0245
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 G0245 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0245 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 G0245
What does HCPCS code G0245 describe?
"Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education" (short descriptor "Initial foot exam pt lops"), in the G section (procedures and professional services, temporary). Added 2002-07-01.
Is G0245 a CPT code?
No. G0245 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0245 CPT code" mean this Level II code.
What does Medicare pay for G0245?
Under the 2026 physician fee schedule (October release) G0245 carries 0.86 work, 1.06 practice-expense and 0.04 malpractice RVUs, which at $33.4009 per RVU pays $65.47 non-facility and $34.74 facility before the locality adjustment. Qualifying APM participants get $65.79 at $33.5675.
Is G0245 an add-on code?
G0245 is a primary code for 1 add-on code (G0247).
How many units of G0245 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 G0245?
No current LCD or billing article lists G0245; its HCPCS coverage code is D (special coverage instructions apply).
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 MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- 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…
- NCCI Add-On Code edits, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file AOC_V2026Q4-F-MCR.xlsxSHA-256 eabb519623134549…
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.