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HCPCS G0460 · Level II · G code

G0460: Autolog prp not diab ulcer, 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 G0460

Medicare payment
$2,107.97
OPPS rate, SI T
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Facility outpatient MUE
1
MAI 3
OPPS status
SI T
Procedure or service, multiple reduction applies
NCCI PTP pairs
223
221 hospital outpatient
LCDs and articles
5 / 5

TL;DR

HCPCS Level II G0460 reads "Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment" in the October 2026 file; it dates from 2012. Hospital outpatient departments are paid $2,107.97 for G0460 under status indicator T, APC 5054 (Level 4 Skin Procedures), minimum unadjusted copayment $421.60 (October 2026 Addendum B). CMS caps G0460 at practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0460 appears in 0 practitioner pairs as column 2 and 223 as column 1, and in 0 hospital outpatient pairs as column 2 and 221 as column 1. 5 active LCDs and 5 billing and coding articles list G0460 across 17 states plus DC and 2 territories: L38745 (Platelet Rich Plasma), L39023 (Platelet Rich Plasma Injections for Non-Wound Injections), A58282, A58737. HCPCS record: BETOS P5E (ambulatory procedures - other); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0459, G0463, G0465, G0454.

G0460 descriptor and code status

The October 2026 HCPCS Level II file describes G0460 as “Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0460 CPT code", G0460 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 G0460
FieldValue
Short descriptorAutolog prp not diab ulcer
Added to HCPCS2012-08-02
Last actionN (no maintenance), effective 2023-07-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryP5E: ambulatory procedures - other
Type of service1: medical care

Medicare payment for G0460

Hospital outpatient departments are paid $2,107.97 for G0460 under status indicator T, APC 5054 (Level 4 Skin Procedures), minimum unadjusted copayment $421.60 (October 2026 Addendum B). 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 C: contractor-priced: the MAC sets RVUs and payment case by case. Global period XXX (global surgery concept does not apply); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator T (Procedure or service, multiple reduction applies), APC 5054 (Level 4 Skin Procedures), national unadjusted payment $2,107.97 with a minimum unadjusted copayment of $421.60.

Medically Unlikely Edits for G0460

CMS caps G0460 at practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure) units per day in the 2026 Q4 MUE tables. The facility outpatient MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for G0460 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalNature of Service/Procedure
Facility outpatient hospital13 Date of Service Edit: ClinicalNature of Service/Procedure

The MUE lookup for G0460 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0460 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 223 (74% modifier-allowed); 57 earlier pairs have been deleted.

Column-2 codes bundled into G0460 (practitioner)
Column-2 codePairs
0213T (CPT; descriptor licensed by AMA)1
0216T (CPT; descriptor licensed by AMA)1
0596T (CPT; descriptor licensed by AMA)1
0597T (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
0903T (CPT; descriptor licensed by AMA)1
0904T (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0460 is the column-2 (bundled) code in 0 active pairs and the column-1 code in 221 (99% modifier-allowed); 57 earlier pairs have been deleted.

Column-2 codes bundled into G0460 (hospital outpatient)
Column-2 codePairs
0213T (CPT; descriptor licensed by AMA)1
0216T (CPT; descriptor licensed by AMA)1
0596T (CPT; descriptor licensed by AMA)1
0597T (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
0903T (CPT; descriptor licensed by AMA)1
0904T (CPT; descriptor licensed by AMA)1

G0460 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 G0460 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0460

5 active Local Coverage Determinations and 5 billing and coding articles list G0460. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

  • L38745 Platelet Rich Plasma · Palmetto GBA
  • L39023 Platelet Rich Plasma Injections for Non-Wound Injections · CGS Administrators, LLC
  • L39058 Platelet Rich Plasma Injections for Non-Wound Injections · Noridian Healthcare Solutions, LLC
  • L39068 Platelet Rich Plasma · Novitas Solutions, Inc.
  • L39071 Platelet Rich Plasma · First Coast Service Options, Inc.
Billing and Coding Articles listing G0460
ArticleTitleContractor(s)Related LCD
A58282Billing and Coding: Platelet Rich PlasmaPalmetto GBAL38745
A58737Billing and Coding: Platelet Rich Plasma Injections for Non-Wound InjectionsCGS Administrators, LLCL39023
A58788Billing and Coding: Platelet Rich Plasma Injections for Non-Wound InjectionsNoridian Healthcare Solutions, LLCL39058
A58808Billing and Coding: Platelet Rich PlasmaNovitas Solutions, Inc.L39068
A58810Billing and Coding: Platelet Rich PlasmaFirst Coast Service Options, Inc.L39071

Denials to expect on G0460

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0460

CARC 151 · N362

units of G0460 exceed the facility outpatient MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for G0460 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0460 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 G0460

What does HCPCS code G0460 describe?

"Autologous platelet rich plasma or other blood-derived product for non-diabetic chronic wounds/ulcers, including as applicable phlebotomy, centrifugation or mixing, and all other preparatory procedures, administration and dressings, per treatment" (short descriptor "Autolog prp not diab ulcer"), in the G section (procedures and professional services, temporary). Added 2012-08-02; last action N (no maintenance) effective 2023-07-01.

Is G0460 a CPT code?

It is not. G0460 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT. "G0460 CPT code" searches refer to it.

What does Medicare pay for G0460?

Hospital outpatient departments are paid $2,107.97 for G0460 under status indicator T, APC 5054 (Level 4 Skin Procedures), minimum unadjusted copayment $421.60 (October 2026 Addendum B).

How many units of G0460 can be billed per day?

CMS caps G0460 at practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure) units per day in the 2026 Q4 MUE tables. For the facility outpatient 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 G0460?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 5 active LCDs and 5 billing and coding articles list G0460 across 17 states plus DC and 2 territories: L38745 (Platelet Rich Plasma), L39023 (Platelet Rich Plasma Injections for Non-Wound Injections), A58282, A58737.

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.