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HCPCS G0537 · Level II · G code

G0537: Administration of a standardized, 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 G0537

Medicare payment
$20.04
PFS non-facility, national; facility $8.02
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 2
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

HCPCS Level II G0537 reads "Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months" in the October 2026 file; it dates from 2025. Medicare's October 2026 physician fee schedule pays G0537 $20.04 non-facility and $8.02 facility nationally, from 0.18 work, 0.41 practice-expense and 0.01 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $20.14 at $33.5675. MUE limits for G0537: practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction). No current LCD or billing article lists G0537; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). HCPCS record: BETOS M5D (specialist - other); pricing indicator 13; type of service 1 (medical care). 1 other active code opens with "Administration of a standardized"; related codes: G0136, G0538, G0539, G0541.

G0537 descriptor and code status

The October 2026 HCPCS Level II file describes G0537 as “Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0537 CPT code", G0537 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 G0537
FieldValue
Short descriptorRisk ascvd tst once pr 12 mo
Added to HCPCS2025-01-01
Last actionN (no maintenance), effective 2025-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator13: physician fee schedule, priced by the contractor
BETOS categoryM5D: specialist - other
Type of service1: medical care

Medicare payment for G0537

Medicare's October 2026 physician fee schedule pays G0537 $20.04 non-facility and $8.02 facility nationally, from 0.18 work, 0.41 practice-expense and 0.01 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $20.14 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 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0537
ComponentNon-facilityFacility
Work RVU0.180.18
Practice expense RVU0.410.05
Malpractice RVU0.010.01
Total RVUs0.600.24
National payment (CF $33.4009)$20.04$8.02
Qualifying APM participant (CF $33.5675)$20.14$8.06
  • Multiple procedures (modifier 51): no multiple-procedure reduction
  • 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 S (Procedure or service, not discounted when multiple), APC 5821 (Level 1 Health and Behavior Services), national unadjusted payment $38.28 with a minimum unadjusted copayment of $7.66.

Medically Unlikely Edits for G0537

MUE limits for G0537: 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 G0537 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 G0537 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0537 in v323r0.

G0537 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 G0537 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0537

No current LCD or billing and coding article lists G0537. 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 G0537

CARC 50 · N115

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

CARC 151 · N362

units of G0537 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 G0537 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0537 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 G0537

What does HCPCS code G0537 describe?

"Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months" (short descriptor "Risk ascvd tst once pr 12 mo"), in the G section (procedures and professional services, temporary). Added 2025-01-01.

Is G0537 a CPT code?

No: CMS maintains G0537 in HCPCS Level II, while the AMA maintains CPT. People do search "G0537 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for G0537?

Medicare's October 2026 physician fee schedule pays G0537 $20.04 non-facility and $8.02 facility nationally, from 0.18 work, 0.41 practice-expense and 0.01 malpractice RVUs at the $33.4009 conversion factor. Qualifying APM participants get $20.14 at $33.5675.

How many units of G0537 can be billed per day?

MUE limits for G0537: 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 G0537?

No current LCD or billing article lists G0537; 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.

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.