HCPCS code G0538 — Ascvd rsk mng clin stf pr mo.
Status: Active.
Effective Jan 1, 2025.
Source: CMS HCPCS Level II.
G0538
ActiveAscvd rsk mng clin stf pr mo
Atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar month
Category:
Procedures
Section:
G-codes: Procedures / Professional Services
Effective:
Jan 1, 2025
Code type:
alphanumeric
OPPS Status:
S
— Significant procedure — not subject to multiple procedure reduction
OPPS APC:
5822
MUE — Medically Unlikely Edits
Maximum units of G0538 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
Change History
Quarterly changes published by CMS. Revisions may affect the code description, coverage, or rate — review each quarter's changes before submitting claims.
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New Code 2025-Q1Ascvd rsk mng clin stf pr mo