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HCPCS G0465 · Level II · G code

G0465: Autologous PRP or other blood-derived product for diabetic chronic wounds/ulcers, 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 G0465

Medicare payment
$1,063.48
PFS non-facility, national; facility $83.84
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
2
MAI 3
OPPS status
SI T
Procedure or service, multiple reduction applies
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 1

TL;DR

G0465 is a Level II code from the G section (procedures and professional services, temporary), in use since 2021: "Autologous platelet rich plasma (prp) or other blood-derived product for diabetic chronic wounds/ulcers, using an fda-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment)". Medicare's October 2026 physician fee schedule pays G0465 $1,063.48 non-facility and $83.84 facility nationally, from 1.78 work, 29.91 practice-expense and 0.15 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $1,068.79 at $33.5675. Global period 000 (0-day global period). MUE limits for G0465: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data). 1 active LCD and 1 billing and coding article list G0465 across 6 states: L39058 (Platelet Rich Plasma Injections for Non-Wound Injections), A58788. HCPCS record: BETOS P5E (ambulatory procedures - other); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0466, G0463, G0467, G0468.

G0465 descriptor and code status

The October 2026 HCPCS Level II file describes G0465 as “Autologous platelet rich plasma (prp) or other blood-derived product for diabetic chronic wounds/ulcers, using an fda-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, 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 "G0465 CPT code", G0465 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 G0465
FieldValue
Short descriptorAutolog prp diab wound ulcer
Added to HCPCS2021-04-13
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 G0465

Medicare's October 2026 physician fee schedule pays G0465 $1,063.48 non-facility and $83.84 facility nationally, from 1.78 work, 29.91 practice-expense and 0.15 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $1,068.79 at $33.5675. Global period 000 (0-day global period). 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 000 (0-day global period); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0465
ComponentNon-facilityFacility
Work RVU1.781.78
Practice expense RVU29.910.58
Malpractice RVU0.150.15
Total RVUs31.842.51
National payment (CF $33.4009)$1,063.48$83.84
Qualifying APM participant (CF $33.5675)$1,068.79$84.25
  • Multiple procedures (modifier 51): standard multiple-procedure reduction (100%, then 50%)
  • Bilateral (modifier 50): 150% bilateral adjustment does not apply
  • Assistant at surgery: assistant at surgery may not be paid; 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 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 G0465

MUE limits for G0465: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (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 G0465 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services23 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital23 Date of Service Edit: ClinicalClinical: Data

The MUE lookup for G0465 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0465 in v323r0.

G0465 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 G0465 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0465

1 active Local Coverage Determination and 1 billing and coding article list G0465. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

  • L39058 Platelet Rich Plasma Injections for Non-Wound Injections · Noridian Healthcare Solutions, LLC
Billing and Coding Articles listing G0465
ArticleTitleContractor(s)Related LCD
A58788Billing and Coding: Platelet Rich Plasma Injections for Non-Wound InjectionsNoridian Healthcare Solutions, LLCL39058

Denials to expect on G0465

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0465

CARC 151 · N362

units of G0465 exceed the practitioner MUE of 2 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 G0465 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0465 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 G0465

What does HCPCS code G0465 describe?

"Autologous platelet rich plasma (prp) or other blood-derived product for diabetic chronic wounds/ulcers, using an fda-cleared device for this indication, (includes as applicable administration, dressings, phlebotomy, centrifugation or mixing, and all other preparatory procedures, per treatment)" (short descriptor "Autolog prp diab wound ulcer"), in the G section (procedures and professional services, temporary). Added 2021-04-13; last action N (no maintenance) effective 2023-07-01.

Is G0465 a CPT code?

No: CMS maintains G0465 in HCPCS Level II, while the AMA maintains CPT. People do search "G0465 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for G0465?

Medicare's October 2026 physician fee schedule pays G0465 $1,063.48 non-facility and $83.84 facility nationally, from 1.78 work, 29.91 practice-expense and 0.15 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $1,068.79 at $33.5675. Global period 000 (0-day global period).

How many units of G0465 can be billed per day?

MUE limits for G0465: practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 2 (MAI 3, Clinical: Data). For the practitioner MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0465?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 active LCD and 1 billing and coding article list G0465 across 6 states: L39058 (Platelet Rich Plasma Injections for Non-Wound Injections), A58788.

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.