G0528 – Management of established patient with dementia, moderate to high complexity, for use in cmmi model

Long description

Management of established patient with dementia, moderate to high complexity, for use in cmmi model

Short description

Mgt est pt dem mod-hi cmplx

Pricing indicator

13 Priced by the Medicare contractor (carrier)

Medicare coverage

C Carrier judgment – coverage decided by the Medicare contractor

BETOS category

Z2 Undefined codes

Added

July 1, 2024

Last change

July 1, 2024 – No change

Nearby G codes

• G0520 – Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model
• G0521 – Management of new patient-caregiver dyad with dementia, high complexity, for use in cmmi model
• G0522 – Management of a new patient with dementia, low complexity, for use in cmmi model
• G0523 – Management of a new patient with dementia, moderate to high complexity, for use in cmmi model
• G0524 – Management of established patient-caregiver dyad with dementia, low complexity, for use in cmmi model
• G0525 – Management of established patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model
• G0526 – Management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model
• G0527 – Management of established patient with dementia, low complexity, for use in cmmi model
• G0529 – In-home respite care, 4-hour unit, for use in cmmi model
• G0530 – Adult day center, 8-hour unit, for use in cmmi model
• G0531 – Facility-based respite, 24-hour unit, for use in cmmi model
• G0532 – Take-home supply of nasal nalmefene hydrochloride; one carton of two, 2.7 mg per 0.1 ml nasal sprays (provision of the services by a medicare-enrolled opioid treatment program);( list separately in addition to each primary code)
• G0533 – Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
• G0534 – Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, which significantly limit the ability to diagnose or treat an opioid use disorder; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
• G0535 – Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
• G0536 – Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or inspiration to meet oud treatment and recovery goals; conducting a person-centered interview to understand the patient's life story, strengths, needs, goals, preferences, and desired outcomes; developing and proposing strategies to help meet person-centered treatment goals; assisting the patient in locating or navigating recovery support services; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)