HCPCS G0276
Pild/placebo control clin tr
Status R Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. Full definition → HCPCS Level II Restricted — special coverage instructions mean payability depends on the circumstances.
Formula
(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor
Citations
-
Physician relative value file (PPRRVU)
PPRRVU16_V0122.csv
in
rvu16a.zip
(row 1,429)
- hcpcs (col 1)
- G0276
- status_code (col 4)
- R
- work_rvu (col 6)
- 7.17
- pe_rvu_nonfacility (col 7)
- 3.03
- pe_rvu_facility (col 9)
- 3.03
- mp_rvu (col 11)
- 1.21
-
Physician relative value file (PPRRVU)
PPRRVU16_V0122.csv
in
rvu16a.zip
(row 11)
- conversion_factor (col 25)
- 35.8043
How much did Medicare pay for HCPCS G0276 in Q1 2016? Copy link
Medicare paid $408.53 for HCPCS G0276 in the office (non-facility) setting and $408.53 in a facility under the Q1 2016 Physician Fee Schedule, effective January 2016. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. Across payment localities, both settings' amount is $345.89–$536.02. This is a 0.4% decrease from the previous quarter.
Source: Physician relative value file (Q1 2016) · effective January 2016 · materially updated Aug 4, 2026 · compact facts
Why isn't there a national PFS amount?
- Status R (Restricted): Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service.
CMS evidence · 2 sources
Open evidence
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Rates by locality Copy link
The amounts above use GPCI 1.000, a national baseline no locality actually bills at. Medicare rescales every code by the local Geographic Practice Cost Indices before paying it, so what G0276 pays depends on where the service is furnished. Tap a state for its localities.
G0276 non-facility rate by metro area
Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.
Anchorage, AK
$536.02
Locality 02102-01
Long Island, NY
$495.65
Locality 13202-02
Queens, NY
$494.63
Locality 13292-04
Miami, FL
$476.66
Locality 09102-04
New York City, NY
$473.20
Locality 13202-01
Chicago, IL
$460.79
Locality 06102-16
Washington, DC
$455.99
Locality 12202-01
Show 47 more metros Show fewer metros
San Francisco, CA
$447.38
Locality 01112-05
Suburban Chicago, IL
$445.34
Locality 06102-15
San Jose, CA
$443.46
Locality 01112-09
Fort Lauderdale, FL
$442.76
Locality 09102-03
Northern New Jersey, NJ
$442.44
Locality 12402-01
Metro East, IL
$439.71
Locality 06102-12
Hartford, CT
$437.87
Locality 13102-00
Philadelphia, PA
$434.79
Locality 12502-01
Los Angeles, CA
$434.07
Locality 01182-18
Baltimore, MD
$432.80
Locality 12302-01
Ventura County, CA
$428.56
Locality 01182-17
New Orleans, LA
$423.58
Locality 07202-01
Detroit, MI
$422.09
Locality 08202-01
Tampa, FL
$417.83
Locality 09102-99
Las Vegas, NV
$414.56
Locality 01312-00
Boston, MA
$413.98
Locality 14212-01
Denver, CO
$413.62
Locality 04112-01
Houston, TX
$412.11
Locality 04412-18
Honolulu, HI
$410.32
Locality 01212-01
Seattle, WA
$409.88
Locality 02402-02
Providence, RI
$409.48
Locality 14412-01
Salt Lake City, UT
$407.39
Locality 03502-09
Albuquerque, NM
$406.71
Locality 04212-05
St. Louis, MO
$404.73
Locality 05302-01
Kansas City, MO
$404.40
Locality 05302-02
Dallas, TX
$404.25
Locality 04412-11
Phoenix, AZ
$403.20
Locality 03102-00
Portland, OR
$402.48
Locality 02302-01
Austin, TX
$400.45
Locality 04412-31
Pittsburgh, PA
$400.26
Locality 12502-99
Fort Worth, TX
$399.39
Locality 04412-28
Columbus, OH
$399.33
Locality 15202-00
Richmond, VA
$399.06
Locality 11302-00
Portland, ME
$393.78
Locality 14112-03
Buffalo, NY
$392.16
Locality 13282-99
San Antonio, TX
$392.14
Locality 04412-99
Charlotte, NC
$390.88
Locality 11502-00
Oklahoma City, OK
$387.93
Locality 04312-00
Charleston, SC
$386.63
Locality 11202-01
Louisville, KY
$385.76
Locality 15102-00
Milwaukee, WI
$384.84
Locality 06302-00
Indianapolis, IN
$383.36
Locality 08102-00
Wichita, KS
$383.36
Locality 05202-00
Minneapolis, MN
$381.19
Locality 06202-00
Boise, ID
$376.15
Locality 02202-00
Des Moines, IA
$375.28
Locality 05102-00
Omaha, NE
$370.91
Locality 05402-00
G0276 facility rate by metro area
Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.
Anchorage, AK
$536.02
Locality 02102-01
Long Island, NY
$495.65
Locality 13202-02
Queens, NY
$494.63
Locality 13292-04
Miami, FL
$476.66
Locality 09102-04
New York City, NY
$473.20
Locality 13202-01
Chicago, IL
$460.79
Locality 06102-16
Washington, DC
$455.99
Locality 12202-01
Show 47 more metros Show fewer metros
San Francisco, CA
$447.38
Locality 01112-05
Suburban Chicago, IL
$445.34
Locality 06102-15
San Jose, CA
$443.46
Locality 01112-09
Fort Lauderdale, FL
$442.76
Locality 09102-03
Northern New Jersey, NJ
$442.44
Locality 12402-01
Metro East, IL
$439.71
Locality 06102-12
Hartford, CT
$437.87
Locality 13102-00
Philadelphia, PA
$434.79
Locality 12502-01
Los Angeles, CA
$434.07
Locality 01182-18
Baltimore, MD
$432.80
Locality 12302-01
Ventura County, CA
$428.56
Locality 01182-17
New Orleans, LA
$423.58
Locality 07202-01
Detroit, MI
$422.09
Locality 08202-01
Tampa, FL
$417.83
Locality 09102-99
Las Vegas, NV
$414.56
Locality 01312-00
Boston, MA
$413.98
Locality 14212-01
Denver, CO
$413.62
Locality 04112-01
Houston, TX
$412.11
Locality 04412-18
Honolulu, HI
$410.32
Locality 01212-01
Seattle, WA
$409.88
Locality 02402-02
Providence, RI
$409.48
Locality 14412-01
Salt Lake City, UT
$407.39
Locality 03502-09
Albuquerque, NM
$406.71
Locality 04212-05
St. Louis, MO
$404.73
Locality 05302-01
Kansas City, MO
$404.40
Locality 05302-02
Dallas, TX
$404.25
Locality 04412-11
Phoenix, AZ
$403.20
Locality 03102-00
Portland, OR
$402.48
Locality 02302-01
Austin, TX
$400.45
Locality 04412-31
Pittsburgh, PA
$400.26
Locality 12502-99
Fort Worth, TX
$399.39
Locality 04412-28
Columbus, OH
$399.33
Locality 15202-00
Richmond, VA
$399.06
Locality 11302-00
Portland, ME
$393.78
Locality 14112-03
Buffalo, NY
$392.16
Locality 13282-99
San Antonio, TX
$392.14
Locality 04412-99
Charlotte, NC
$390.88
Locality 11502-00
Oklahoma City, OK
$387.93
Locality 04312-00
Charleston, SC
$386.63
Locality 11202-01
Louisville, KY
$385.76
Locality 15102-00
Milwaukee, WI
$384.84
Locality 06302-00
Indianapolis, IN
$383.36
Locality 08102-00
Wichita, KS
$383.36
Locality 05202-00
Minneapolis, MN
$381.19
Locality 06202-00
Boise, ID
$376.15
Locality 02202-00
Des Moines, IA
$375.28
Locality 05102-00
Omaha, NE
$370.91
Locality 05402-00
Q1 2016 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range — its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.
How this amount is computed Copy link
HCPCS G0276 has a work RVU of 7.17, a non-facility practice expense RVU of 3.03, a facility practice expense RVU of 3.03 and a malpractice RVU of 1.21 — for total non-facility RVUs of 11.41 and total facility RVUs of 11.41 in the Q1 2016 release.
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.
| Component | RVU |
|---|---|
| Work RVU | 7.17 |
| Practice expense RVU (non-facility) | 3.03 |
| Practice expense RVU (facility) | 3.03 |
| Malpractice RVU | 1.21 |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.
What does G0276 cost? Copy link
Four numbers get called the cost of a code. Each answers a different question.
Computed from the Q1 2016 CMS release
- Medicare allowed amount
- $408.53
- Medicare's share
- $326.82
- Patient coinsurance
- $81.71
- Limiting charge
- $446.32
What Medicare recognizes as the full price for G0276 in the office (non-facility) setting. Every figure below derives from it.
80% of the allowed amount, before the ~2% sequestration cut.
The remaining 20%, once the annual Part B deductible is met. Medigap or Medicaid often covers it.
The ceiling a non-participating provider can bill a patient on an unassigned claim — 109.25% of the allowed amount.
National Q1 2016 figures at GPCI 1.000. Adjust for your locality and sequestration, or see the questions below for each figure in full.
Common questions Copy link
Is $408.53 what a practice actually receives?
It's the national allowed amount — the starting point. Medicare pays 80% of it ($326.82) and the patient owes 20% coinsurance ($81.71). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. What lands is practice revenue: staff, space, equipment and billing, not clinician take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.
Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).
What's the non-participating amount for G0276?
$388.10 in the office (non-facility) setting — 95% of the $408.53 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
What's the limiting charge for G0276?
$446.32 in the office (non-facility) setting — the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $408.53 amount above. The non-participating amount is 95% of the fee schedule rate ($388.10), and the statutory cap is 115% of that. See limiting charge.
Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.
Why would a Medicare claim for G0276 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is R (restricted) — Special coverage instructions apply, so whether Medicare pays depends on the circumstances of the service. See status indicators
- Co-surgeons: payable with documentation. See billing policy
- Team surgery: not permitted. See billing policy
- Multiple procedures: standard reduction applies. See billing policy
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.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. The G0276 rate last moved in Q1 2026 (+1.4% non-facility) — see its rate history or what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Applicable payment rules Copy link
Only the rules that can matter for G0276, each linking to its detail on this page.
Global period: what G0276's fee already covers Copy link
The fee covers pre-operative and post-operative work on the day of the procedure only — there is no follow-up window afterward. A visit the next day is separately payable.
| Modifier | Reports |
|---|---|
| -25 | A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care. |
A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.
Billing policy Copy link
What G0276's billing-policy indicators mean. These show for every code, priced or not: a restriction like "bilateral not allowed" still matters on a carrier-priced code. See modifier amounts below for the dollar figures these support.
| Policy | Value | What it means |
|---|---|---|
| Bilateral surgery | 2 | RVUs already reflect bilateral pricing. The published RVUs already account for a bilateral procedure — no additional bilateral adjustment applies on top of the fee schedule amount. |
| Assistant at surgery | 2 | Payable. An assistant at surgery may be separately paid for this procedure, typically as a percentage of the fee schedule amount. |
| Co-surgeons | 1 | Payable with documentation. Co-surgeons may be paid, but only with supporting documentation establishing the medical necessity of two surgeons. |
| Team surgery | 0 | Not permitted. Medicare does not recognize a surgical team (modifier 66) for this procedure. |
| Multiple procedures | 2 | Standard reduction applies. The same standard ranking-and-reduction rule as indicator 1 applies to this procedure when billed with others on the same date. |
| Professional/technical split | 0 | No PC/TC split. This is a physician service code; the professional/technical split does not apply, and the code is billed as a single service. |
Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link
National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.
| Modifier | What it means | Amount |
|---|---|---|
| -26/TC | Professional/technical split | Not payable |
| -50 | Bilateral procedure (100%) | $408.53 |
| -80/81/82 | Assistant surgeon (physician) (16%) | $65.36 |
| -AS | Assistant at surgery (PA, NP, or CNS) (13.6%) | $55.56 |
| -62 | Co-surgeons, each (62.5%) | $255.33 If documented |
| -66 | Team surgery | Not payable |
These apply standard MPFS percentages — assistant surgeon 16%, co-surgeon 62.5%, bilateral 150% — to the national non-facility amount above, so its source citation covers them too. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator pays it only when supporting documentation of medical necessity is submitted — an unpaid claim without that documentation is not an underpayment.
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 G0276.
Rate history by release Copy link
National non-facility amount for G0276 across quarterly releases. -12.1% decrease since Q1 2015 · high $410.76 in Q1 2018
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jul 1, 2026 – present | R | $358.73 (0.0% no change ) | $358.73 (0.0% no change ) |
| Q2 2026 Apr 1, 2026 – Jun 30, 2026 | R | $358.73 (0.0% no change ) | $358.73 (0.0% no change ) |
| Q1 2026 Jan 1, 2026 – Mar 31, 2026 | R | $358.73 (+1.4% increase ) | $358.73 (+1.4% increase ) |
| Q4 2025 Oct 1, 2025 – Dec 31, 2025 | R | $353.87 (0.0% no change ) | $353.87 (0.0% no change ) |
| Q3 2025 Jul 1, 2025 – Sep 30, 2025 | R | $353.87 (0.0% no change ) | $353.87 (0.0% no change ) |
| Q2 2025 Apr 1, 2025 – Jun 30, 2025 | R | $353.87 (0.0% no change ) | $353.87 (0.0% no change ) |
| Q1 2025 Jan 1, 2025 – Mar 31, 2025 | R | $353.87 (-2.9% decrease ) | $353.87 (-2.9% decrease ) |
| Q4 2024 Oct 1, 2024 – Dec 31, 2024 | R | $364.50 (0.0% no change ) | $364.50 (0.0% no change ) |
| Q3 2024 Jul 1, 2024 – Sep 30, 2024 | R | $364.50 (0.0% no change ) | $364.50 (0.0% no change ) |
| Q2 2024 Apr 1, 2024 – Jun 30, 2024 | R | $364.50 (0.0% no change ) | $364.50 (0.0% no change ) |
| Q1 2024 Jan 1, 2024 – Mar 31, 2024 | R | $364.50 (-1.7% decrease ) | $364.50 (-1.7% decrease ) |
| Q4 2023 Oct 1, 2023 – Dec 31, 2023 | R | $370.73 (0.0% no change ) | $370.73 (0.0% no change ) |
| Q3 2023 Jul 1, 2023 – Sep 30, 2023 | R | $370.73 (0.0% no change ) | $370.73 (0.0% no change ) |
| Q2 2023 Apr 1, 2023 – Jun 30, 2023 | R | $370.73 (0.0% no change ) | $370.73 (0.0% no change ) |
| Q1 2023 Jan 1, 2023 – Mar 31, 2023 | R | $370.73 (-2.4% decrease ) | $370.73 (-2.4% decrease ) |
| Q4 2022 Oct 1, 2022 – Dec 31, 2022 | R | $379.98 (0.0% no change ) | $379.98 (0.0% no change ) |
| Q3 2022 Jul 1, 2022 – Sep 30, 2022 | R | $379.98 (0.0% no change ) | $379.98 (0.0% no change ) |
| Q2 2022 Apr 1, 2022 – Jun 30, 2022 | R | $379.98 (0.0% no change ) | $379.98 (0.0% no change ) |
| Q1 2022 Jan 1, 2022 – Mar 31, 2022 | R | $379.98 (-0.5% decrease ) | $379.98 (-0.5% decrease ) |
| Q4 2021 Oct 1, 2021 – Dec 31, 2021 | R | $381.73 (0.0% no change ) | $381.73 (0.0% no change ) |
| Q3 2021 Jul 1, 2021 – Sep 30, 2021 | R | $381.73 (0.0% no change ) | $381.73 (0.0% no change ) |
| Q2 2021 Apr 1, 2021 – Jun 30, 2021 | R | $381.73 (0.0% no change ) | $381.73 (0.0% no change ) |
| Q1 2021 Jan 1, 2021 – Mar 31, 2021 | R | $381.73 (-1.7% decrease ) | $381.73 (-1.7% decrease ) |
| Q4 2020 Oct 1, 2020 – Dec 31, 2020 | R | $388.32 (0.0% no change ) | $388.32 (0.0% no change ) |
| Q3 2020 Jul 1, 2020 – Sep 30, 2020 | R | $388.32 (0.0% no change ) | $388.32 (0.0% no change ) |
| Q2 2020 Apr 1, 2020 – Jun 30, 2020 | R | $388.32 (0.0% no change ) | $388.32 (0.0% no change ) |
| Q1 2020 Jan 1, 2020 – Mar 31, 2020 | R | $388.32 (+1.5% increase ) | $388.32 (+1.5% increase ) |
| Q4 2019 Oct 1, 2019 – Dec 31, 2019 | R | $382.74 (0.0% no change ) | $382.74 (0.0% no change ) |
| Q3 2019 Jul 1, 2019 – Sep 30, 2019 | R | $382.74 (0.0% no change ) | $382.74 (0.0% no change ) |
| Q2 2019 Apr 1, 2019 – Jun 30, 2019 | R | $382.74 (0.0% no change ) | $382.74 (0.0% no change ) |
| Q1 2019 Jan 1, 2019 – Mar 31, 2019 | R | $382.74 (-6.8% decrease ) | $382.74 (-6.8% decrease ) |
| Q4 2018 Oct 1, 2018 – Dec 31, 2018 | R | $410.76 (0.0% no change ) | $410.76 (0.0% no change ) |
| Q3 2018 Jul 1, 2018 – Sep 30, 2018 | R | $410.76 (0.0% no change ) | $410.76 (0.0% no change ) |
| Q2 2018 Apr 1, 2018 – Jun 30, 2018 | R | $410.76 (0.0% no change ) | $410.76 (0.0% no change ) |
| Q1 2018 Jan 1, 2018 – Mar 31, 2018 | R | $410.76 (+0.3% increase ) | $410.76 (+0.3% increase ) |
| Q4 2017 Oct 1, 2017 – Dec 31, 2017 | R | $409.49 (0.0% no change ) | $409.49 (0.0% no change ) |
| Q3 2017 Jul 1, 2017 – Sep 30, 2017 | R | $409.49 (0.0% no change ) | $409.49 (0.0% no change ) |
| Q2 2017 Apr 1, 2017 – Jun 30, 2017 | R | $409.49 (0.0% no change ) | $409.49 (0.0% no change ) |
| Q1 2017 Jan 1, 2017 – Mar 31, 2017 | R | $409.49 (+0.2% increase ) | $409.49 (+0.2% increase ) |
| Q4 2016 Oct 1, 2016 – Dec 31, 2016 | R | $408.53 (0.0% no change ) | $408.53 (0.0% no change ) |
| Q3 2016 Jul 1, 2016 – Sep 30, 2016 | R | $408.53 (0.0% no change ) | $408.53 (0.0% no change ) |
| Q2 2016 Apr 1, 2016 – Jun 30, 2016 | R | $408.53 (0.0% no change ) | $408.53 (0.0% no change ) |
| Q1 2016 Jan 1, 2016 – Mar 31, 2016 | R | $408.53 (-0.4% decrease ) | $408.53 (-0.4% decrease ) |
| Q4 2015 Oct 1, 2015 – Dec 31, 2015 | R | $410.00 (+0.5% increase ) | $410.00 (+0.5% increase ) |
| Q3 2015 Jul 1, 2015 – Sep 30, 2015 | R | $407.96 (0.0% no change ) | $407.96 (0.0% no change ) |
| Q2 2015 Apr 1, 2015 – Jun 30, 2015 | R | $407.96 (0.0% no change ) | $407.96 (0.0% no change ) |
| Q1 2015 Jan 1, 2015 – Mar 31, 2015 | R | $407.96 | $407.96 |
Contracted rate: % of Medicare Copy link
Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what G0276 pays at that rate — $408.53 is 100%.
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Source & method
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This is computed from CMS's Medicare Physician Fee Schedule Q1 2016 release (schedule pfs, effective January 2016). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. CMS owns the code description shown for HCPCS Level II codes. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.
Conversion factor $35.8043 read from the same file, row 11, column 25.
Use the (i) buttons next to each amount above for the exact row, columns, and math.
Cite this rate
This link keeps pointing at the Q1 2016 figures, even after a newer release lands.
HCPCS G0276 Medicare Physician Fee Schedule rate: $408.53 (Q1 2016). Localis. https://localishealth.com/hcpcs/G0276/2016/A