G0380
ActiveLev 1 hosp type b ed visit
Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)
MUE — Medically Unlikely Edits
Maximum units of G0380 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| Outpatient Hospital | 2 |
| Practitioner Services | 0 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NCCI Edits
The following codes cannot be billed together with G0380 without appropriate documentation.
| Column 2 Code | Modifier |
|---|---|
| G0102 | Modifier may bypass edit |
| G0245 | Modifier may bypass edit |
| G0246 | Modifier may bypass edit |
| G0271 | Modifier may bypass edit |
| G0498 | Modifier may bypass edit |
Source: CMS National Correct Coding Initiative (NCCI)
NCCI Edits — Reverse Direction
G0380 cannot be billed together with the following column 1 codes without appropriate documentation.
| Column 1 Code | Modifier |
|---|---|
| G0101 | Modifier may bypass edit |
| G0104 | Modifier may bypass edit |
| G0105 | Modifier may bypass edit |
| G0121 | Modifier may bypass edit |
| G0127 | Modifier may bypass edit |
| G0302 | Modifier may bypass edit |
| G0303 | Modifier may bypass edit |
| G0304 | Modifier may bypass edit |
| G0305 | Modifier may bypass edit |
| G0381 | Modifier may bypass edit |
| G0382 | Modifier may bypass edit |
| G0383 | Modifier may bypass edit |
| G0384 | Modifier may bypass edit |
| G0402 | Modifier may bypass edit |
| G0410 | Modifier may bypass edit |
| G0411 | Modifier may bypass edit |
| G0491 | Modifier may bypass edit |
| G0492 | Modifier may bypass edit |
| G0500 | Modifier may bypass edit |
| P3000 | Modifier may bypass edit |
| P3001 | Modifier may bypass edit |
| Q0091 | Modifier may bypass edit |
| Q2043 | Modifier may bypass edit |
Source: CMS National Correct Coding Initiative (NCCI)