G0531 – Facility-based respite, 24-hour unit, for use in cmmi model

Long description

Facility-based respite, 24-hour unit, for use in cmmi model

Short description

Fclty-based respite, 24 hr u

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

• 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
• G0528 – Management of established patient with dementia, moderate to high 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
• 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)
• G0537 – Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months
• G0538 – Atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar month
• G0539 – Caregiver training in behavior management/modification for caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face; initial 30 minutes