On December 23, 2005, CMS implemented a streamlined PVRP by reducing the number of quality indicators to be reported using G-Code indicators from the original 36 to a “core set” of 16 special quality indicators. The revision was described in a new MedLearn Matters Release (MM 4183) and was implemented as of January 3, 2006.
IMPORTANT POINTS FOR PHYSICIANS
*When applicable, the G-Code should be reported in addition to CPT and ICD-9 codes required for appropriate claims coding.
*They do not substitute for CPT and ICD-9 codes requirements for payment.
*They are not associated with a separate fee, and will not be individually compensated.
*G-Codes are always billed in conjunction with a service and are never billed independently.
*The G-Codes should be reported with a submitted charge of zero ($0.00). (G-Codes will not appear on the Medicare Physician Fee Schedule Data Base (MPFSDB) because there are no relative value units (RVUs) or amounts for these codes.)
*They are not specialty specific. Therefore, a medical specialty may report G-Codes classified under other specialties. However, it is anticipated that the reporting of certain G-Codes will be predominated by certain specialties.
*The failure to provide a G-Code will not result in denial of a claim that would otherwise be approved, and thus submission of a G-Code is voluntary.
