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HCPCS G0516 · Level II · G code

G0516: Insertion of non-biodegradable drug delivery implants, 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). 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.

Key facts for G0516

Medicare payment
$175.02
PFS non-facility, national; facility $84.84
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI Q1
STV-Packaged Codes
NCCI PTP pairs
55
51 hospital outpatient
LCDs and articles
0 / 0

TL;DR

HCPCS Level II G0516 reads "Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)" in the October 2026 file; it dates from 2018. Medicare's October 2026 physician fee schedule pays G0516 $175.02 non-facility and $84.84 facility nationally, from 1.77 work, 3.32 practice-expense and 0.15 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $175.89 at $33.5675. Global period 000 (0-day global period). MUE limits for G0516: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). In the NCCI PTP files v323r0 G0516 appears in 5 practitioner pairs as column 2 and 50 as column 1 (most often with 11981, 11983, 20700), and in 2 hospital outpatient pairs as column 2 and 49 as column 1. G0516 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD. HCPCS record: BETOS P6C (minor procedures - other (Medicare fee schedule)); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0514, G0513, G0508, G0506.

G0516 descriptor and code status

The October 2026 HCPCS Level II file describes G0516 as “Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0516
FieldValue
Short descriptorInsert drug del implant, >=4
Added to HCPCS2018-01-01
Last actionN (no maintenance), effective 2018-04-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryP6C: minor procedures - other (Medicare fee schedule)
Type of service1: medical care

Medicare payment for G0516

Medicare's October 2026 physician fee schedule pays G0516 $175.02 non-facility and $84.84 facility nationally, from 1.77 work, 3.32 practice-expense and 0.15 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $175.89 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 G0516
ComponentNon-facilityFacility
Work RVU1.771.77
Practice expense RVU3.320.62
Malpractice RVU0.150.15
Total RVUs5.242.54
National payment (CF $33.4009)$175.02$84.84
Qualifying APM participant (CF $33.5675)$175.89$85.26
  • 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 paid only with documentation; 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 Q1 (STV-Packaged Codes), APC 5735 (Level 5 Minor Procedures), national unadjusted payment $456.40 with a minimum unadjusted copayment of $91.28.

Ambulatory surgical center (Addendum AA)

Payment indicator N1 (Packaged service/item; no separate payment made).

Medically Unlikely Edits for G0516

MUE limits for G0516: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). The practitioner MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0516 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for G0516 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0516 is the column-2 (bundled) code in 5 active pairs, 0% of which allow a modifier and the column-1 code in 50 (92% modifier-allowed); 1 earlier pair has been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.

Column-1 codes most often paired with G0516 (practitioner)
Column-1 codePairs
11981 (CPT; descriptor licensed by AMA)1
11983 (CPT; descriptor licensed by AMA)1
20700 (CPT; descriptor licensed by AMA)1
20702 (CPT; descriptor licensed by AMA)1
20704 (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into G0516 (practitioner)
Column-2 codePairs
0213T (CPT; descriptor licensed by AMA)1
0216T (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
11000 (CPT; descriptor licensed by AMA)1
11001 (CPT; descriptor licensed by AMA)1
11004 (CPT; descriptor licensed by AMA)1
11005 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0516 is the column-2 (bundled) code in 2 active pairs, 0% of which allow a modifier and the column-1 code in 49 (92% modifier-allowed); 0 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: Mutually exclusive procedures.

Column-1 codes most often paired with G0516 (hospital outpatient)
Column-1 codePairs
11981 (CPT; descriptor licensed by AMA)1
11983 (CPT; descriptor licensed by AMA)1
Column-2 codes bundled into G0516 (hospital outpatient)
Column-2 codePairs
0213T (CPT; descriptor licensed by AMA)1
0216T (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
11000 (CPT; descriptor licensed by AMA)1
11001 (CPT; descriptor licensed by AMA)1
11004 (CPT; descriptor licensed by AMA)1
11005 (CPT; descriptor licensed by AMA)1

G0516 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 G0516 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0516

No current LCD or billing and coding article lists G0516. 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 G0516

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of G0516 exceed the practitioner 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 G0516 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0516 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 G0516

What does HCPCS code G0516 describe?

"Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)" (short descriptor "Insert drug del implant, >=4"), in the G section (procedures and professional services, temporary). Added 2018-01-01; last action N (no maintenance) effective 2018-04-01.

Is G0516 a CPT code?

No: CMS maintains G0516 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for G0516?

Medicare's October 2026 physician fee schedule pays G0516 $175.02 non-facility and $84.84 facility nationally, from 1.77 work, 3.32 practice-expense and 0.15 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $175.89 at $33.5675. Global period 000 (0-day global period).

How many units of G0516 can be billed per day?

MUE limits for G0516: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). For the practitioner MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0516?

G0516 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code C (carrier judgment, so the Medicare contractor decides coverage) and any NCD.

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.