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HCPCS G2086 · Level II · G code

G2086: Office-based treatment for opioid use disorder, 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 G2086

Medicare payment
$491.33
PFS non-facility, national; facility $362.73
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Practitioner MUE
1
MAI 3
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0
on the Medicare telehealth list

TL;DR

HCPCS Level II G2086 reads "Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month" in the October 2026 file; it dates from 2020. National PFS payment for G2086 is $491.33 in an office and $362.73 in a facility (October 2026), built from 8.36 work, 5.73 practice-expense and 0.62 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $493.78 at $33.5675. CMS caps G2086 at practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. G2086 is a primary code for 1 add-on code (G2088). G2086 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. It is on the CY2026 Medicare telehealth list (CMS action: Maintain). HCPCS record: BETOS M5D (specialist - other); pricing indicator 13; type of service 1 (medical care). 2 other active codes open with "Office-based treatment for opioid use disorder"; related codes: G2087, G2088, G2083, G2082.

G2086 descriptor and code status

The October 2026 HCPCS Level II file describes G2086 as “Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G2086 CPT code", G2086 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 G2086
FieldValue
Short descriptorOff base opioid tx 70min
Added to HCPCS2020-01-01
Last actionN (no maintenance), effective 2020-01-01
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 G2086

National PFS payment for G2086 is $491.33 in an office and $362.73 in a facility (October 2026), built from 8.36 work, 5.73 practice-expense and 0.62 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $493.78 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 G2086
ComponentNon-facilityFacility
Work RVU8.368.36
Practice expense RVU5.731.88
Malpractice RVU0.620.62
Total RVUs14.7110.86
National payment (CF $33.4009)$491.33$362.73
Qualifying APM participant (CF $33.5675)$493.78$364.54
  • 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 5823 (Level 3 Health and Behavior Services), national unadjusted payment $181.34 with a minimum unadjusted copayment of $36.27.

Medically Unlikely Edits for G2086

CMS caps G2086 at practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. 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 G2086 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalCode Descriptor / CPT Instruction
Facility outpatient hospital13 Date of Service Edit: ClinicalCode Descriptor / CPT Instruction

The MUE lookup for G2086 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists G2086 in v323r0.

G2086 is a designated primary code for 1 add-on code (G2088).

Pair counts show exposure, not the answer for one claim. Check G2086 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G2086

No current LCD or billing and coding article lists G2086. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Telehealth status

G2086 is on the CY2026 Medicare telehealth services list (CMS action: Maintain). Bill it with the place-of-service code and modifiers that match where the patient and the practitioner are on the date of service.

Denials to expect on G2086

CARC 50 · N115

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

CARC 151 · N362

units of G2086 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 G2086 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G2086 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 G2086

What does HCPCS code G2086 describe?

"Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy and group therapy and counseling; at least 70 minutes in the first calendar month" (short descriptor "Off base opioid tx 70min"), in the G section (procedures and professional services, temporary). Added 2020-01-01.

Is G2086 a CPT code?

It is not. G2086 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT. "G2086 CPT code" searches refer to it.

What does Medicare pay for G2086?

National PFS payment for G2086 is $491.33 in an office and $362.73 in a facility (October 2026), built from 8.36 work, 5.73 practice-expense and 0.62 malpractice RVUs at $33.4009 per RVU. Qualifying APM participants get $493.78 at $33.5675.

Is G2086 an add-on code?

G2086 is a primary code for 1 add-on code (G2088).

How many units of G2086 can be billed per day?

CMS caps G2086 at practitioner 1 (MAI 3, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 3, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. 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 G2086?

G2086 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.

Can G2086 be billed as telehealth?

Yes. G2086 is on the CY2026 Medicare telehealth list (Maintain); the place-of-service and modifier rules on the date of service still apply.

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.