Skip to main content
HCPCS G0378 · Level II · G code

G0378: Hospital observation service, per hour, 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 G0378

Medicare payment
no PFS amount
PFS status X
Coverage code
D
special coverage instructions apply
Practitioner MUE
0
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
20
11 hospital outpatient
LCDs and articles
1 / 1

TL;DR

HCPCS Level II G0378 reads "Hospital observation service, per hour" in the October 2026 file; it dates from 2006. The physician fee schedule lists G0378 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. MUE limits for G0378: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 72 (MAI 3, Clinical: Data). In the NCCI PTP files v323r0 G0378 appears in 11 practitioner pairs as column 2 and 9 as column 1 (most often with 98000, 98001, 98002), and in 11 hospital outpatient pairs as column 2 and 0 as column 1. 1 active LCD and 1 billing and coding article list G0378 across 7 states: L34552 (Outpatient Observation Bed/Room Services), A56673. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS M2A (hospital visit - initial); pricing indicator 00; type of service 1 (medical care). Nearby codes: G0379, G0380, G0381, G0382.

G0378 descriptor and code status

The October 2026 HCPCS Level II file describes G0378 as “Hospital observation service, per hour”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0378 CPT code", G0378 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 G0378
FieldValue
Short descriptorHospital observation per hr
Added to HCPCS2006-01-01
Last actionN (no maintenance), effective 2006-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator00: not separately priced by Part B
BETOS categoryM2A: hospital visit - initial
Type of service1: medical care

Medicare payment for G0378

The physician fee schedule lists G0378 with status X (statutory exclusion: not a physician service under the fee schedule), 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 X: statutory exclusion: not a physician service under the fee schedule. 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 N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Medically Unlikely Edits for G0378

MUE limits for G0378: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 72 (MAI 3, Clinical: Data). 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 G0378 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital723 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for G0378 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0378 is the column-2 (bundled) code in 11 active pairs, 100% of which allow a modifier and the column-1 code in 9 (0% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.

Column-1 codes most often paired with G0378 (practitioner)
Column-1 codePairs
98000 (CPT; descriptor licensed by AMA)1
98001 (CPT; descriptor licensed by AMA)1
98002 (CPT; descriptor licensed by AMA)1
98003 (CPT; descriptor licensed by AMA)1
98004 (CPT; descriptor licensed by AMA)1
98005 (CPT; descriptor licensed by AMA)1
98006 (CPT; descriptor licensed by AMA)1
98007 (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into G0378 (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
99446 (CPT; descriptor licensed by AMA)1
99447 (CPT; descriptor licensed by AMA)1
99448 (CPT; descriptor licensed by AMA)1
99449 (CPT; descriptor licensed by AMA)1
99451 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0378 is the column-2 (bundled) code in 11 active pairs, 100% of which allow a modifier and the column-1 code in 0; 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.

Column-1 codes most often paired with G0378 (hospital outpatient)
Column-1 codePairs
98000 (CPT; descriptor licensed by AMA)1
98001 (CPT; descriptor licensed by AMA)1
98002 (CPT; descriptor licensed by AMA)1
98003 (CPT; descriptor licensed by AMA)1
98004 (CPT; descriptor licensed by AMA)1
98005 (CPT; descriptor licensed by AMA)1
98006 (CPT; descriptor licensed by AMA)1
98007 (CPT; descriptor licensed by AMA)1

G0378 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 G0378 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0378

1 active Local Coverage Determination and 1 billing and coding article list G0378. 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 G0378
ArticleTitleContractor(s)Related LCD
A56673Billing and Coding: Outpatient Observation Bed/Room ServicesPalmetto GBAL34552

Denials to expect on G0378

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0378

CARC 151 · N362

units of G0378 exceed the practitioner MUE of 0 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 G0378 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0378 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 G0378

What does HCPCS code G0378 describe?

"Hospital observation service, per hour" (short descriptor "Hospital observation per hr"), in the G section (procedures and professional services, temporary). Added 2006-01-01.

Is G0378 a CPT code?

No: CMS maintains G0378 in HCPCS Level II, while the AMA maintains CPT. People do search "G0378 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for G0378?

The physician fee schedule lists G0378 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it.

How many units of G0378 can be billed per day?

MUE limits for G0378: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 72 (MAI 3, Clinical: Data). For the practitioner MUE (MAI 3), units above 0 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0378?

Coverage code D (special coverage instructions apply). 1 active LCD and 1 billing and coding article list G0378 across 7 states: L34552 (Outpatient Observation Bed/Room Services), A56673.

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.