Key facts for G0281
- Medicare payment
- $11.69
- PFS non-facility, national
- Coverage code
- C
- carrier judgment, so the Medicare contractor decides coverage
- Practitioner MUE
- 1
- MAI 3
- NCCI PTP pairs
- 18
- 15 hospital outpatient
- LCDs and articles
- 6 / 6
TL;DR
G0281 is a Level II code from the G section (procedures and professional services, temporary), in use since 2003: "Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care". Under the 2026 physician fee schedule (October release) G0281 carries 0.18 work, 0.16 practice-expense and 0.01 malpractice RVUs, which at $33.4009 per RVU pays $11.69 non-facility and no facility amount facility before the locality adjustment. Qualifying APM participants get $11.75 at $33.5675. Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction). In the NCCI PTP files v323r0 G0281 appears in 10 practitioner pairs as column 2 and 8 as column 1 (most often with 20974, 64580, 77600), and in 10 hospital outpatient pairs as column 2 and 5 as column 1. 6 active LCDs and 6 billing and coding articles list G0281 across 27 states plus DC: L33631 (Outpatient Physical and Occupational Therapy Services), L33942 (Physical Therapy - Home Health), A53064, A53065. OPPS status indicator A: Services not paid under OPPS; paid under fee schedule or other payment system. HCPCS record: BETOS P5E (ambulatory procedures - other); pricing indicator 11; type of service 1 (medical care), U (occupational therapy), W (physical therapy). 2 other active codes open with "Electrical stimulation"; related codes: G0282, G0283, G0279, G0278.
G0281 descriptor and code status
The October 2026 HCPCS Level II file describes G0281 as “Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0281 CPT code", G0281 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 | Elec stim unattend for press |
| Added to HCPCS | 2003-04-01 |
| Last action | N (no maintenance), effective 2003-04-01 |
| Coverage code | C: carrier judgment, so the Medicare contractor decides coverage |
| Pricing indicator | 11: physician fee schedule, priced with national RVUs |
| BETOS category | P5E: ambulatory procedures - other |
| Type of service | 1: medical care; U: occupational therapy; W: physical therapy |
Medicare payment for G0281
Under the 2026 physician fee schedule (October release) G0281 carries 0.18 work, 0.16 practice-expense and 0.01 malpractice RVUs, which at $33.4009 per RVU pays $11.69 non-facility and no facility amount facility before the locality adjustment. Qualifying APM participants get $11.75 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 7 (physical therapy service not payable in hospital settings).
| Component | Non-facility | Facility |
|---|---|---|
| Work RVU | 0.18 | 0.18 |
| Practice expense RVU | 0.16 | NA |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVUs | 0.35 | NA |
| National payment (CF $33.4009) | $11.69 | n/a |
| Qualifying APM participant (CF $33.5675) | $11.75 | n/a |
- Multiple procedures (modifier 51): 50% practice-expense reduction for certain therapy services
- 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 A (Services not paid under OPPS; paid under fee schedule or other payment system), with no separate OPPS payment rate.
Medically Unlikely Edits for G0281
Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.
| Setting | MUE (units/DOS) | MAI | CMS rationale |
|---|---|---|---|
| Practitioner services | 1 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
| Facility outpatient hospital | 1 | 3 Date of Service Edit: Clinical | Code Descriptor / CPT Instruction |
The MUE lookup for G0281 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, G0281 is the column-2 (bundled) code in 10 active pairs, 100% of which allow a modifier and the column-1 code in 8 (50% modifier-allowed); 6 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Standards of medical/surgical practice.
| Column-1 code | Pairs |
|---|---|
| 20974 (CPT; descriptor licensed by AMA) | 1 |
| 64580 (CPT; descriptor licensed by AMA) | 1 |
| 77600 (CPT; descriptor licensed by AMA) | 1 |
| 77605 (CPT; descriptor licensed by AMA) | 1 |
| 77610 (CPT; descriptor licensed by AMA) | 1 |
| 77615 (CPT; descriptor licensed by AMA) | 1 |
| 77620 (CPT; descriptor licensed by AMA) | 1 |
| G0151 Hhcp-serv of pt,ea 15 min | 1 |
| 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 |
| 97032 (CPT; descriptor licensed by AMA) | 1 |
| 97164 (CPT; descriptor licensed by AMA) | 1 |
| 97168 (CPT; descriptor licensed by AMA) | 1 |
| G0283 Elec stim other than wound | 1 |
| G0329 Electromagntic tx for ulcers | 1 |
In the hospital outpatient PTP file v323r0, G0281 is the column-2 (bundled) code in 10 active pairs, 100% of which allow a modifier and the column-1 code in 5 (80% modifier-allowed); 6 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Standards of medical/surgical practice.
| Column-1 code | Pairs |
|---|---|
| 20974 (CPT; descriptor licensed by AMA) | 1 |
| 64580 (CPT; descriptor licensed by AMA) | 1 |
| 77600 (CPT; descriptor licensed by AMA) | 1 |
| 77605 (CPT; descriptor licensed by AMA) | 1 |
| 77610 (CPT; descriptor licensed by AMA) | 1 |
| 77615 (CPT; descriptor licensed by AMA) | 1 |
| 77620 (CPT; descriptor licensed by AMA) | 1 |
| G0151 Hhcp-serv of pt,ea 15 min | 1 |
G0281 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 G0281 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for G0281
6 active Local Coverage Determinations and 6 billing and coding articles list G0281. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.
- LCD L33631: Outpatient Physical and Occupational Therapy Services · Wellpoint Federal
- Physical Therapy - Home Health, LCD L33942 · CGS Administrators, LLC
- Outpatient Occupational Therapy (L34427) · Palmetto GBA
- LCD L34428: Outpatient Physical Therapy · Palmetto GBA
- Wound Care, LCD L37228 · Wisconsin Physicians Service Insurance Corporation
- L34049 Outpatient Physical and Occupational Therapy Services · CGS Administrators, LLC
| Article | Title | Contractor(s) | Related LCD |
|---|---|---|---|
| A53064 | Billing and Coding: Outpatient Occupational Therapy | Palmetto GBA | L34427 |
| A53065 | Billing and Coding: Outpatient Physical Therapy | Palmetto GBA | L34428 |
| A55909 | Billing and Coding: Wound Care | Wisconsin Physicians Service Insurance Corporation | L37227, L37228 |
| A56566 | Billing and Coding: Outpatient Physical and Occupational Therapy Services | Wellpoint Federal | L33631 |
| A57067 | Billing and Coding: Outpatient Physical and Occupational Therapy Services | CGS Administrators, LLC | L34049 |
| A57311 | Billing and Coding: Physical Therapy - Home Health | CGS Administrators, LLC | L33942 |
Denials to expect on G0281
the diagnosis or documentation does not meet the LCD or billing article that lists G0281
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 G0281 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0281 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 G0281
What does HCPCS code G0281 describe?
"Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care" (short descriptor "Elec stim unattend for press"), in the G section (procedures and professional services, temporary). Added 2003-04-01.
Is G0281 a CPT code?
No. G0281 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0281 CPT code" mean this Level II code.
What does Medicare pay for G0281?
Under the 2026 physician fee schedule (October release) G0281 carries 0.18 work, 0.16 practice-expense and 0.01 malpractice RVUs, which at $33.4009 per RVU pays $11.69 non-facility and no facility amount facility before the locality adjustment. Qualifying APM participants get $11.75 at $33.5675.
How many units of G0281 can be billed per day?
Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction). For the practitioner MUE (MAI 3), units above 1 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.
Does Medicare cover G0281?
Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 6 active LCDs and 6 billing and coding articles list G0281 across 27 states plus DC: L33631 (Outpatient Physical and Occupational Therapy Services), L33942 (Physical Therapy - Home Health), A53064, A53065.
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…
- 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.