G0516 Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)...
HCPCS Procedure & Supply Codes
G0516 - Insertion of non-biodegradable drug delivery implants, 4 or more (services for subdermal rod implant)
The above description is abbreviated. This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information.
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The above description is abbreviated. This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information.
Additional Code Information includes:
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HCPCS Index Entries (Reverse Index Lookup) 
reverse_index/reverse_index_content.php?set=HCPCS&c=G0516
View historical information about the code including when it was added, changed, deleted, etc. Access to this feature is available in the following products:
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Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. Access to this feature is available in the following products:
Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. |
Medicare Processing Note #0008
THIS PROCESSING NOTE DELETED 1/1/97.
Medicare - Carrier Priced
Subscribers will see related documentation, coding and billing tips. Access to this feature is available in the following products:
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DMEPOS Products (Durable Medical Equipment, Prosthetics, Orthotics, Supplies)
dmepos/dmepos_content.php?set=HCPCS&c=G0516
Calculated for National Unadjusted (00000)
* Note: Medicare may or may NOT reimburse you for this code. The fees provided below are based on values established by CMS/Medicare. Please check with your local Medicare contact on whether this code is eligible for reimbursement.
Medicare vs. My Fee Evaluation
| Modifier | Medicare Allowed | 150% | 200% | My Fee |
|---|---|---|---|---|
| (none) | $95.54 | $143.30 | $191.07 | (your fee) |
| (MPPR) | $47.60 | $71.40 | $95.20 | (your fee) |
Access to calculated fee values is available. Access to this feature is available in the following products:
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Medicare Participating - Assignment Accepted (Mandatory)
| Modifier | Allowed | Medicare 80% | Patient Pays |
|---|---|---|---|
| (none) | $95.54 | $##.## | $##.## |
| (MPPR) | $47.60 | $##.## | $##.## |
Medicare Non-Participating - Assignment Accepted (Check To Doctor)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
| (MPPR) | $##.## | $##.## | $##.## | $##.## |
Medicare Non-Participating - Assignment NOT Accepted (Check To Patient)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
| (MPPR) | $##.## | $##.## | $##.## | $##.## |
Medicare vs. My Fee Evaluation
| Modifier | Medicare Allowed | 150% | 200% | My Fee |
|---|---|---|---|---|
| (none) | $196.40 | $294.59 | $392.79 | (your fee) |
| (MPPR) | $98.20 | $147.30 | $196.40 | (your fee) |
Access to calculated fee values is available. Access to this feature is available in the following products:
Note: Subscribers will see the calculated values below. |
Medicare Participating - Assignment Accepted (Mandatory)
| Modifier | Allowed | Medicare 80% | Patient Pays |
|---|---|---|---|
| (none) | $196.40 | $##.## | $##.## |
| (MPPR) | $98.20 | $##.## | $##.## |
Medicare Non-Participating - Assignment Accepted (Check To Doctor)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
| (MPPR) | $##.## | $##.## | $##.## | $##.## |
Medicare Non-Participating - Assignment NOT Accepted (Check To Patient)
| Modifier | Allowed | Medicare 80% | Patient Pays | Limiting Charge (Amount Billed) |
|---|---|---|---|---|
| (none) | $##.## | $##.## | $##.## | $##.## |
| (MPPR) | $##.## | $##.## | $##.## | $##.## |
This section shows APC information including: Status Indicator, Relative Weight, Payment Rate, Crosswalks, and more. Access to this feature is available in the following products:
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View fees for this code from 4 different built-in fee schedules and from those you've added using the Compare-A-Fee™ tool. If you work with several fee schedules or would like to create custom fee comparison reports, you need our exclusive Compare-A-Fee™ tool.
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View a table of UCR, Worker's Comp, and Medicare Fees here, as well as see UCR Fees in the charts below. Access to this feature is available in the following products:
Note: Subscribers will see the fee graphs below. |
View a chart showing the last 8+ years of Medicare denial rates, Medicare Allowed amounts, and Medicare billed amounts. Access to this feature is available in the following products:
Note: Subscribers will see the fee graphs below. |
Calculated for National Unadjusted (00000)
* Note: Medicare may or may NOT reimburse you for this code. The fees provided below are based on values established by CMS/Medicare. Please check with your local Medicare contact on whether this code is eligible for reimbursement.
RVU Components (by modifier)
| Modifier | Work | Practice Expense | Malpractice Expense | Total |
|---|---|---|---|---|
| (none) | 1.82 | 0.94 | 0.11 | 2.870 |
| (MPPR) | 0.91 | 0.47 | 0.05 | 1.430 |
Access to calculated fee values is available. Access to this feature is available in the following products:
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Practitioner Labor
| Pre-Service | Intra-Service | Post-Service | Total Time* |
|---|---|---|---|
| ## | ## | ## | ## min |
* Total Time may be greater than the displayed components.
Work RVU Components (by modifier)
| Modifier | National Unadjusted Work RVU | Work GPCI | Adjusted Work RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 1.82 |
| (MPPR) | ##.## | ##.## | 0.91 |
Clinical Labor - Direct Expense
| Staff | Staff Rate | Pre Time | Intra Time | Post Time | Total Time |
|---|---|---|---|---|---|
| RN/LPN/MTA | $0.50 / min | ## min | ## min | ## min | ## min |
Equipment - Direct Expense
| Item | Purchase Price | Expected Life | Total Time |
|---|---|---|---|
| table, instrument, mobile | $##.## | ## years | ## min |
| table, power | $##.## | ## years | ## min |
| instrument pack, basic ($500-$1499) | $##.## | ## years | ## min |
| light, exam | $##.## | ## years | ## min |
Supplies - Direct Expense
| Item | Unit Price | Quantity | Unit | Amount |
|---|---|---|---|---|
| pack, minimum multi-specialty visit | $##.## | ## | pack | $##.## |
| drape, sterile, for Mayo stand | $##.## | ## | item | $##.## |
| drape, sterile, hand-upper extremity | $##.## | ## | item | $##.## |
| gloves, sterile | $##.## | ## | pair | $##.## |
| gown, staff, impervious | $##.## | ## | item | $##.## |
| cap-headcover, patient | $##.## | ## | item | $##.## |
| mask, surgical, with face shield | $##.## | ## | item | $##.## |
| shoe covers, surgical | $##.## | ## | pair | $##.## |
| underpad 2ft x 3ft (Chux) | $##.## | ## | item | $##.## |
| syringe w-needle, OSHA compliant (SafetyGlide) | $##.## | ## | item | $##.## |
| blade, surgical, super-sharp | $##.## | ## | item | $##.## |
| adhesive, skin (Dermabond) | $##.## | ## | item | $##.## |
| bandage, elastic wrap 6in (Ace) | $##.## | ## | item | $##.## |
| bandage, strip 0.75in x 3in (Bandaid) | $##.## | ## | item | $##.## |
| gauze, sterile 4in x 4in | $##.## | ## | item | $##.## |
| steri-strip (6 strip uou) | $##.## | ## | item | $##.## |
| lidocaine 1%-2% inj (Xylocaine) | $##.## | ## | ml | $##.## |
| povidone swabsticks (3 pack uou) | $##.## | ## | item | $##.## |
| swab-pad, alcohol | $##.## | ## | item | $##.## |
| swab, patient prep, 3.0 ml (chloraprep) | $##.## | ## | item | $##.## |
Indirect Expenses (clerical,overhead, and other) are also included in the practice expense.
PE RVU Components (by modifier)
| Modifier | National Unadjusted PE RVU | PE GPCI | Adjusted PE RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 0.940 |
| (MPPR) | ##.## | ##.## | 0.470 |
RVU Components (by modifier)
| Modifier | Work | Practice Expense | Malpractice Expense | Total |
|---|---|---|---|---|
| (none) | 1.82 | 3.97 | 0.11 | 5.900 |
| (MPPR) | 0.91 | 1.99 | 0.05 | 2.950 |
Access to calculated fee values is available. Access to this feature is available in the following products:
Note: Subscribers will see the calculated values below. |
Practitioner Labor
| Pre-Service | Intra-Service | Post-Service | Total Time* |
|---|---|---|---|
| ## | ## | ## | ## min |
* Total Time may be greater than the displayed components.
Work RVU Components (by modifier)
| Modifier | National Unadjusted Work RVU | Work GPCI | Adjusted Work RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 1.82 |
| (MPPR) | ##.## | ##.## | 0.91 |
Clinical Labor (Non-Facility)- Direct Expense
| Staff | Staff Rate | Pre Time | Intra Time | Post Time | Total Time |
|---|---|---|---|---|---|
| RN/LPN/MTA | $0.50 / min | ## min | ## min | ## min | ## min |
Equipment (Non-Facility)- Direct Expense
| Item | Purchase Price | Expected Life | Total Time |
|---|---|---|---|
| table, instrument, mobile | $##.## | ## years | ## min |
| table, power | $##.## | ## years | ## min |
| instrument pack, basic ($500-$1499) | $##.## | ## years | ## min |
| light, exam | $##.## | ## years | ## min |
Supplies (Non-Facility)- Direct Expense
| Item | Unit Price | Quantity | Unit | Amount |
|---|---|---|---|---|
| pack, minimum multi-specialty visit | $##.## | ## | pack | $##.## |
| drape, sterile, for Mayo stand | $##.## | ## | item | $##.## |
| drape, sterile, hand-upper extremity | $##.## | ## | item | $##.## |
| gloves, sterile | $##.## | ## | pair | $##.## |
| gown, staff, impervious | $##.## | ## | item | $##.## |
| cap-headcover, patient | $##.## | ## | item | $##.## |
| mask, surgical, with face shield | $##.## | ## | item | $##.## |
| shoe covers, surgical | $##.## | ## | pair | $##.## |
| underpad 2ft x 3ft (Chux) | $##.## | ## | item | $##.## |
| syringe w-needle, OSHA compliant (SafetyGlide) | $##.## | ## | item | $##.## |
| blade, surgical, super-sharp | $##.## | ## | item | $##.## |
| adhesive, skin (Dermabond) | $##.## | ## | item | $##.## |
| bandage, elastic wrap 6in (Ace) | $##.## | ## | item | $##.## |
| bandage, strip 0.75in x 3in (Bandaid) | $##.## | ## | item | $##.## |
| gauze, sterile 4in x 4in | $##.## | ## | item | $##.## |
| steri-strip (6 strip uou) | $##.## | ## | item | $##.## |
| lidocaine 1%-2% inj (Xylocaine) | $##.## | ## | ml | $##.## |
| povidone swabsticks (3 pack uou) | $##.## | ## | item | $##.## |
| swab-pad, alcohol | $##.## | ## | item | $##.## |
| swab, patient prep, 3.0 ml (chloraprep) | $##.## | ## | item | $##.## |
Indirect Expenses (clerical,overhead, and other) are also included in the practice expense.
PE RVU Components (by modifier)
| Modifier | National Unadjusted PE RVU | PE GPCI | Adjusted PE RVU |
|---|---|---|---|
| (none) | ##.## | ##.## | 3.970 |
| (MPPR) | ##.## | ##.## | 1.990 |
View relationships (or crosswalks) between code sets. Access to this feature is available in the following products:
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Medicare Policies & Guidelines (Articles, LCDs, NCDs)
coverage/coverage_content.php?set=HCPCS&c=G0516
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