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HCPCS G0554 · Level II · G code

G0554: Add 20 m of monthly tx, 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 G0554

Medicare payment
$41.42
PFS non-facility, national; facility $25.38
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0
add-on code

TL;DR

CMS describes HCPCS G0554, added in 2025, as "Each additional 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing data generated from the dmht device from patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month". Under the 2026 physician fee schedule (October release) G0554 carries 0.61 work, 0.60 practice-expense and 0.03 malpractice RVUs, which at $33.4009 per RVU pays $41.42 non-facility and $25.38 facility before the locality adjustment. Qualifying APM participants get $41.62 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period). Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). G0554 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 1 primary code such as G0553. G0554 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. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS M5D (specialist - other); pricing indicator 13; type of service 1 (medical care). Nearby codes: G0553, G0557, G0560, G0545.

G0554 descriptor and code status

The October 2026 HCPCS Level II file describes G0554 as “Each additional 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing data generated from the dmht device from patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0554
FieldValue
Short descriptorAdd 20 m of monthly tx
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 G0554

Under the 2026 physician fee schedule (October release) G0554 carries 0.61 work, 0.60 practice-expense and 0.03 malpractice RVUs, which at $33.4009 per RVU pays $41.42 non-facility and $25.38 facility before the locality adjustment. Qualifying APM participants get $41.62 at $33.5675. Global period ZZZ (add-on service inside the primary service's 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 ZZZ (add-on service inside the primary service's global period); PC/TC indicator 0 (physician service; the professional/technical split does not apply).

PFS relative values and national payment for G0554
ComponentNon-facilityFacility
Work RVU0.610.61
Practice expense RVU0.600.12
Malpractice RVU0.030.03
Total RVUs1.240.76
National payment (CF $33.4009)$41.42$25.38
Qualifying APM participant (CF $33.5675)$41.62$25.51
  • 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 N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Medically Unlikely Edits for G0554

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). 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 G0554 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalNature of Service/Procedure
Facility outpatient hospital13 Date of Service Edit: ClinicalNature of Service/Procedure

The MUE lookup for G0554 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G0554 in v323r0.

G0554 is an add-on code: it is payable only with a primary service on the same claim (G0553). CPT primary codes are shown as numbers only.

Pair counts show exposure, not the answer for one claim. Check G0554 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0554

No current LCD or billing and coding article lists G0554. 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 G0554

CARC 50 · N115

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

CARC 151 · N362

units of G0554 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 G0554 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0554 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 G0554

What does HCPCS code G0554 describe?

"Each additional 20 minutes of monthly treatment management services directly related to the patient's therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional time reviewing data generated from the dmht device from patient observations and patient specific inputs in a calendar month and requiring at least one interactive communication with the patient/caregiver during the calendar month" (short descriptor "Add 20 m of monthly tx"), in the G section (procedures and professional services, temporary). Added 2025-01-01.

Is G0554 a CPT code?

No. G0554 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for G0554?

Under the 2026 physician fee schedule (October release) G0554 carries 0.61 work, 0.60 practice-expense and 0.03 malpractice RVUs, which at $33.4009 per RVU pays $41.42 non-facility and $25.38 facility before the locality adjustment. Qualifying APM participants get $41.62 at $33.5675. Global period ZZZ (add-on service inside the primary service's global period).

Is G0554 an add-on code?

G0554 is an add-on code (NCCI edit type 1): Medicare pays it only on a claim that also carries one of 1 primary code such as G0553.

How many units of G0554 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 1 (MAI 3, Nature of Service/Procedure); hospital outpatient 1 (MAI 3, Nature of Service/Procedure). 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 G0554?

G0554 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.

CMS guidance

The Medicare Learning Network publication that CMS issues on this topic, cited by ICN and publication date:

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.