HCPCS code G0500 — Mod sedat endo service >5yrs. Status: Active. Effective Jan 1, 2017. Source: CMS HCPCS Level II.

G0500

Active

Mod sedat endo service >5yrs

Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)

Category: Procedures
Section: G-codes: Procedures / Professional Services
Effective: Jan 1, 2017
Code type: alphanumeric
OPPS Status: N — Items / services packaged into APC rates

MUE — Medically Unlikely Edits

Maximum units of G0500 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 1
Practitioner Services 1

Source: CMS Medicare NCCI Medically Unlikely Edits

NCCI Edits

The following codes cannot be billed together with G0500 without appropriate documentation.

Column 2 Code Modifier
G0380 Modifier may bypass edit
G0381 Modifier may bypass edit
G0382 Modifier may bypass edit
G0383 Modifier may bypass edit
G0384 Modifier may bypass edit
G0463 Modifier may bypass edit

Source: CMS National Correct Coding Initiative (NCCI)

NCCI Edits — Reverse Direction

G0500 cannot be billed together with the following column 1 codes without appropriate documentation.

Column 1 Code Modifier
G0339 Modifier cannot bypass edit
G0340 Modifier cannot bypass edit
G0458 Modifier cannot bypass edit

Source: CMS National Correct Coding Initiative (NCCI)