Key facts for G0498
- Medicare payment
- $337.46
- OPPS rate, SI S
- Coverage code
- C
- carrier judgment, so the Medicare contractor decides coverage
- Facility outpatient MUE
- 1
- MAI 2
- NCCI PTP pairs
- 108
- 94 hospital outpatient
- LCDs and articles
- 0 / 0
TL;DR
G0498 is a Level II code from the G section (procedures and professional services, temporary), in use since 2016: "Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion". Hospital outpatient departments are paid $337.46 for G0498 under status indicator S, APC 5694 (Level 4 Drug Administration), minimum unadjusted copayment $67.50 (October 2026 Addendum B). MUE limits for G0498: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). In the NCCI PTP files v323r0 G0498 appears in 67 practitioner pairs as column 2 and 41 as column 1 (most often with 36823, 77750, 79403), and in 56 hospital outpatient pairs as column 2 and 38 as column 1. No current LCD or billing article lists G0498; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). HCPCS record: BETOS P7B (oncology - other); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0499, G0500, G0491, G0506.
G0498 descriptor and code status
The October 2026 HCPCS Level II file describes G0498 as “Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0498 CPT code", G0498 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 | Chemo extend iv infus w/pump |
| Added to HCPCS | 2016-01-01 |
| Last action | N (no maintenance), effective 2016-01-01 |
| Coverage code | C: carrier judgment, so the Medicare contractor decides coverage |
| Pricing indicator | 13: physician fee schedule, priced by the contractor |
| BETOS category | P7B: oncology - other |
| Type of service | 1: medical care |
Medicare payment for G0498
Hospital outpatient departments are paid $337.46 for G0498 under status indicator S, APC 5694 (Level 4 Drug Administration), minimum unadjusted copayment $67.50 (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 YYY (the contractor sets the global period); PC/TC indicator 5 (incident-to service).
Hospital outpatient (OPPS Addendum B)
Status indicator S (Procedure or service, not discounted when multiple), APC 5694 (Level 4 Drug Administration), national unadjusted payment $337.46 with a minimum unadjusted copayment of $67.50.
Medically Unlikely Edits for G0498
MUE limits for G0498: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). The facility outpatient 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 G0498 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, G0498 is the column-2 (bundled) code in 67 active pairs, 79% of which allow a modifier and the column-1 code in 41 (85% modifier-allowed); 99 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Standards of medical/surgical practice.
| Column-1 code | Pairs |
|---|---|
| 36823 (CPT; descriptor licensed by AMA) | 1 |
| 77750 (CPT; descriptor licensed by AMA) | 1 |
| 79403 (CPT; descriptor licensed by AMA) | 1 |
| 96416 (CPT; descriptor licensed by AMA) | 1 |
| 99221 (CPT; descriptor licensed by AMA) | 1 |
| 99222 (CPT; descriptor licensed by AMA) | 1 |
| 99223 (CPT; descriptor licensed by AMA) | 1 |
| 99231 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 0708T (CPT; descriptor licensed by AMA) | 1 |
| 0709T (CPT; descriptor licensed by AMA) | 1 |
| 11900 (CPT; descriptor licensed by AMA) | 1 |
| 11901 (CPT; descriptor licensed by AMA) | 1 |
| 36000 (CPT; descriptor licensed by AMA) | 1 |
| 36410 (CPT; descriptor licensed by AMA) | 1 |
| 36500 (CPT; descriptor licensed by AMA) | 1 |
| 36591 (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, G0498 is the column-2 (bundled) code in 56 active pairs, 96% of which allow a modifier and the column-1 code in 38 (92% modifier-allowed); 88 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Standards of medical/surgical practice.
| Column-1 code | Pairs |
|---|---|
| 36823 (CPT; descriptor licensed by AMA) | 1 |
| 77750 (CPT; descriptor licensed by AMA) | 1 |
| 79403 (CPT; descriptor licensed by AMA) | 1 |
| 96416 (CPT; descriptor licensed by AMA) | 1 |
| 99221 (CPT; descriptor licensed by AMA) | 1 |
| 99222 (CPT; descriptor licensed by AMA) | 1 |
| 99223 (CPT; descriptor licensed by AMA) | 1 |
| 99231 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 0708T (CPT; descriptor licensed by AMA) | 1 |
| 0709T (CPT; descriptor licensed by AMA) | 1 |
| 11900 (CPT; descriptor licensed by AMA) | 1 |
| 11901 (CPT; descriptor licensed by AMA) | 1 |
| 36000 (CPT; descriptor licensed by AMA) | 1 |
| 36410 (CPT; descriptor licensed by AMA) | 1 |
| 36500 (CPT; descriptor licensed by AMA) | 1 |
| 64450 (CPT; descriptor licensed by AMA) | 1 |
G0498 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 G0498 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for G0498
No current LCD or billing and coding article lists G0498. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.
Denials to expect on G0498
the modifier reported is inconsistent with the code
the claim lacks the description, invoice or pricing detail a contractor-priced code needs
Where QuickIntell fits for G0498 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0498 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 G0498
What does HCPCS code G0498 describe?
"Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion" (short descriptor "Chemo extend iv infus w/pump"), in the G section (procedures and professional services, temporary). Added 2016-01-01.
Is G0498 a CPT code?
No: CMS maintains G0498 in HCPCS Level II, while the AMA maintains CPT. People do search "G0498 CPT code", and it goes in the same procedure-code field.
What does Medicare pay for G0498?
Hospital outpatient departments are paid $337.46 for G0498 under status indicator S, APC 5694 (Level 4 Drug Administration), minimum unadjusted copayment $67.50 (October 2026 Addendum B).
How many units of G0498 can be billed per day?
MUE limits for G0498: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). For the facility outpatient MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.
Does Medicare cover G0498?
No current LCD or billing article lists G0498; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).
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…
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.