Key facts for G0500
- Medicare payment
- $66.47
- PFS non-facility, national; facility $5.34
- Coverage code
- C
- carrier judgment, so the Medicare contractor decides coverage
- Practitioner MUE
- 1
- MAI 3
- NCCI PTP pairs
- 442
- 434 hospital outpatient
- LCDs and articles
- 0 / 1
TL;DR
G0500 is a Level II code from the G section (procedures and professional services, temporary), in use since 2017: "Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)". Under the 2026 physician fee schedule (October release) G0500 carries 0.10 work, 1.86 practice-expense and 0.03 malpractice RVUs, which at $33.4009 per RVU pays $66.47 non-facility and $5.34 facility before the locality adjustment. Qualifying APM participants get $66.80 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). G0500 is a primary code for 1 add-on code (99153). In the NCCI PTP files v323r0 G0500 appears in 337 practitioner pairs as column 2 and 105 as column 1 (most often with 00100, 00102, 00103), and in 337 hospital outpatient pairs as column 2 and 97 as column 1. 1 billing and coding article lists G0500 across 7 states: A58559. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS P0 (anesthesia); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0499, G0498, G0506, G0508.
G0500 descriptor and code status
The October 2026 HCPCS Level II file describes G0500 as “Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0500 CPT code", G0500 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 | Mod sedat endo service >5yrs |
| Added to HCPCS | 2017-01-01 |
| Last action | N (no maintenance), effective 2017-01-01 |
| Coverage code | C: carrier judgment, so the Medicare contractor decides coverage |
| Pricing indicator | 13: physician fee schedule, priced by the contractor |
| BETOS category | P0: anesthesia |
| Type of service | 1: medical care |
Medicare payment for G0500
Under the 2026 physician fee schedule (October release) G0500 carries 0.10 work, 1.86 practice-expense and 0.03 malpractice RVUs, which at $33.4009 per RVU pays $66.47 non-facility and $5.34 facility before the locality adjustment. Qualifying APM participants get $66.80 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 9 (professional/technical concept does not apply).
| Component | Non-facility | Facility |
|---|---|---|
| Work RVU | 0.10 | 0.10 |
| Practice expense RVU | 1.86 | 0.03 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVUs | 1.99 | 0.16 |
| National payment (CF $33.4009) | $66.47 | $5.34 |
| Qualifying APM participant (CF $33.5675) | $66.80 | $5.37 |
- Multiple procedures (modifier 51): multiple-procedure concept does not apply
- Bilateral (modifier 50): bilateral concept does not apply
- Assistant at surgery: assistant-at-surgery concept does not apply; co-surgeons: co-surgery concept does not apply; team surgery: team-surgery concept does not apply
- Physician supervision of diagnostic procedures: supervision 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 G0500
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 G0500 shows every setting next to any other code on the same claim.
NCCI edits and add-on rules
In the practitioner PTP file v323r0, G0500 is the column-2 (bundled) code in 337 active pairs, 0% of which allow a modifier and the column-1 code in 105 (95% modifier-allowed); 133 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.
| Column-1 code | Pairs |
|---|---|
| 00100 (CPT; descriptor licensed by AMA) | 1 |
| 00102 (CPT; descriptor licensed by AMA) | 1 |
| 00103 (CPT; descriptor licensed by AMA) | 1 |
| 00104 (CPT; descriptor licensed by AMA) | 1 |
| 00120 (CPT; descriptor licensed by AMA) | 1 |
| 00124 (CPT; descriptor licensed by AMA) | 1 |
| 00126 (CPT; descriptor licensed by AMA) | 1 |
| 00140 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 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 |
| 0905T (CPT; descriptor licensed by AMA) | 1 |
| 36000 (CPT; descriptor licensed by AMA) | 1 |
| 36400 (CPT; descriptor licensed by AMA) | 1 |
| 36405 (CPT; descriptor licensed by AMA) | 1 |
In the hospital outpatient PTP file v323r0, G0500 is the column-2 (bundled) code in 337 active pairs, 100% of which allow a modifier and the column-1 code in 97 (100% modifier-allowed); 127 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: CPT Manual or CMS manual coding instruction.
| Column-1 code | Pairs |
|---|---|
| 00100 (CPT; descriptor licensed by AMA) | 1 |
| 00102 (CPT; descriptor licensed by AMA) | 1 |
| 00103 (CPT; descriptor licensed by AMA) | 1 |
| 00104 (CPT; descriptor licensed by AMA) | 1 |
| 00120 (CPT; descriptor licensed by AMA) | 1 |
| 00124 (CPT; descriptor licensed by AMA) | 1 |
| 00126 (CPT; descriptor licensed by AMA) | 1 |
| 00140 (CPT; descriptor licensed by AMA) | 1 |
| Column-2 code | Pairs |
|---|---|
| 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 |
| 0905T (CPT; descriptor licensed by AMA) | 1 |
| 36000 (CPT; descriptor licensed by AMA) | 1 |
| 36400 (CPT; descriptor licensed by AMA) | 1 |
| 36405 (CPT; descriptor licensed by AMA) | 1 |
G0500 is a designated primary code for 1 add-on code (99153).
Pair counts show exposure, not the answer for one claim. Check G0500 against a second code to see whether the pair bundles and whether a modifier can separate the services.
Medicare coverage policies for G0500
0 active Local Coverage Determinations and 1 billing and coding article list G0500. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.
| Article | Title | Contractor(s) | Related LCD |
|---|---|---|---|
| A58559 | Billing and Coding: Independent Diagnostic Testing Facilities (IDTF) | Palmetto GBA | — |
Denials to expect on G0500
the diagnosis or documentation does not meet the LCD or billing article that lists G0500
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 G0500 claims
QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0500 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 G0500
What does HCPCS code G0500 describe?
"Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)" (short descriptor "Mod sedat endo service >5yrs"), in the G section (procedures and professional services, temporary). Added 2017-01-01.
Is G0500 a CPT code?
No. G0500 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set. Searches for "G0500 CPT code" mean this Level II code.
What does Medicare pay for G0500?
Under the 2026 physician fee schedule (October release) G0500 carries 0.10 work, 1.86 practice-expense and 0.03 malpractice RVUs, which at $33.4009 per RVU pays $66.47 non-facility and $5.34 facility before the locality adjustment. Qualifying APM participants get $66.80 at $33.5675.
Is G0500 an add-on code?
G0500 is a primary code for 1 add-on code (99153).
How many units of G0500 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 G0500?
Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 billing and coding article lists G0500 across 7 states: A58559.
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…
- NCCI Add-On Code edits, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file AOC_V2026Q4-F-MCR.xlsxSHA-256 eabb519623134549…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file article.csvSHA-256 5e95c4a8ac3664be…
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.