Compliance Officers' Forum

Guidance on Billing HCPCS Code G0538 ASCVD risk management services

  • 1.  Guidance on Billing HCPCS Code G0538 ASCVD risk management services

    Posted 20 days ago

    Good morning, 

    I am seeking input on whether anyone is currently billing HCPCS Code G0538. If so, how have you operationalized the consent process, care plan development, and monthly outreach to meet the code requirements?

    We have had multiple discussions with our clinicians, and the consensus is that the effort required to satisfy these requirements may not justify the time investment.

    Additionally, since this is not a time-based code:

    • What are the minimum requirements that must be met each month to bill?
    • Can this code be billed consecutively month after month?

    Your insights and best practices would be greatly appreciated. Thank you!



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    Noel Wagner
    Director Physician Compliance
    UNC Health
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