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HCPCS G0521 Medicare payment status

Priced under CLFS

G0521 · PFS Q3 2026 · Historical

Status X is not separately payable under the PFS.

View applicable payment rules
View CMS source and method

CMS RVU26CJuly 1 – September 30, 2026

PFS status evidence

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 15,247)
Inspect PFS status evidence
Code
G0521
Release
Q3 2026, revision 1
Result
Priced under CLFS

Citations

  • Shows this code’s PFS status (X). Result: Priced under CLFS.

    Physician relative value file (PPRRVU)CMS RVU26CJuly 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.

    PPRRVU2026_Jul_nonQPP.csv row 15,247 in rvu26c-updated-06-30-2026.zip

    In the CMS file

    Loading rows 15,245–15,249 of PPRRVU2026_Jul_nonQPP.csv…

    Download rvu26c-updated-06-30-2026.zip from CMS File fingerprint b7d197e73211ef6854c213c267d5fa9dec8df995db8e1ee7d44c0556ad7cee21

Plain-text summaryReport a problem

HCPCS G0521 has no published national rate. It carries status X (statutory exclusion) in the Q3 2026 release. The statutory definition of physician services does not include this item. The blank amount means unpriced, not $0.

Why is there no national PFS amount for G0521?

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

New pt-cg dyad dem hig cmplx

Which billing rules and modifiers apply? Copy link

Payment rules for G0521 Copy link

Other fee-schedule routing Applies
Other payment indicators (9)
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, NCCI same-day edits: Does not apply, MUE behavior: Not determined, Contractor pricing: Does not apply.
Why would a Medicare claim for G0521 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

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.

Global period: what G0521'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

Check a pair of codes 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 for the pair.

See every current NCCI pair for G0521 →

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for G0521 across quarterly releases.

Release Status Office Facility
Q4 2026 Oct 1, 2026 – present 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 and related codes Copy link

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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. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. CMS owns the code description shown for HCPCS Level II codes. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 15,247)

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

HCPCS G0521 National PFS baseline: No national PFS rate (Q3 2026; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU26C, PPRRVU2026_Jul_nonQPP.csv row 15,247. Localis. https://localishealth.com/hcpcs/G0521/2026/C