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Q4 2026 starts Oct 1, 2026. Preview changes

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HCPCS G0152

Priced under CLFS

G0152 · PFS Q3 2026

Status X is not separately payable under the PFS.

View applicable payment rules

Not at a published national rate. HCPCS G0152 carries status X (statutory exclusion) in the Q3 2026 release. The statutory definition of physician services does not include this item. Treat the blank amount as unpriced, not as $0.

PFS status evidence

Inspect PFS status evidence
Code
G0152
Release
Q3 2026, revision 1
Result
Priced under CLFS

Citations

  • Establishes the PFS status (X) and the resulting pathway for this code: priced under clfs.

    Physician relative value file (PPRRVU)

    Q3 2026 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2026

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    Record details PPRRVU2026_Jul_nonQPP.csv in rvu26c-updated-06-30-2026.zip (row 15,046)
    hcpcs (col 1)
    G0152
    modifier (col 2)
    blank
    status_code (col 4)
    X

    SHA-256: b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

    Original source file

Compact facts

Why is there no national PFS amount for G0152?

Its status indicator is X (statutory exclusion). The statutory definition of physician services does not include this item. Status X is not separately payable under the PFS.

About this code

Hhcp-serv of ot,ea 15 min

Payment considerations Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

Other payment indicators (8)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, MUE behavior: Not determined, Contractor pricing: Does not apply.

Payment rules

Global period: what G0152's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and G0152.

See every current NCCI pair for G0152 →

Billing together (NCCI edits) Copy link

NCCI Q3 2026

Based on CMS's National Correct Coding Initiative (NCCI). A few examples appear here; use the complete edit page to check a specific pair.

Not separately payable with G0152 on the same date of service—no modifier bypasses the edit (modifier indicator 0)

36591 36591 denies
36592 36592 denies
96523 96523 denies

Showing 3 of 7.

Separately payable with G0152 only when an NCCI-associated modifier is appropriate and documented (modifier indicator 1)

97150 97150 denies
97165 97165 denies
97166 97166 denies

Showing 3 of 11.

Modifier 59 and the X modifiers are not a universal bypass—CMS expects the most specific applicable modifier, and which one that is depends on the pair and the documented circumstances.

Check a paired code or view all 18 NCCI pairs →

Common payment questions Copy link

Why would a Medicare claim for G0152 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is X (statutory exclusion)—The statutory definition of physician services does not include this item. See status indicators
  • 7 codes form NCCI pairs with G0152 carrying modifier indicator 0—no NCCI-associated modifier bypasses the edit, so billed together on the same date of service, a line of the pair denies. See billing together
  • 11 codes pair with G0152 under modifier indicator 1—separately payable only when an NCCI-associated modifier (59, or a more specific XE, XS, XP, or XU) is clinically appropriate and the documentation supports a distinct service; without one, a line of the pair denies. See billing together

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

History

Rate history by release Copy link

National non-facility amount for G0152 across quarterly releases.

Release Status Non-facility Facility
Q4 2026 takes effect Oct 1, 2026 X
Q3 2026 Jul 1, 2026 – Sep 30, 2026 X
Q2 2026 Apr 1, 2026 – Jun 30, 2026 X
When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Usage & related

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q3 2026 release (effective July 2026). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. CMS owns the code description shown for HCPCS Level II codes. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

HCPCS G0152 National PFS baseline: No national PFS rate (Q3 2026; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/hcpcs/G0152/2026/C