2025 HCPCS Code G0137

Intensive outpatient services; weekly bundle, minimum of 9 services over a 7 contiguous day period, which can include individual and group therapy with physicians or psychologists (or other mental health professionals to the extent authorized under state law); occupational therapy requiring the skills of a qualified occupational therapist; services of social workers, trained psychiatric nurses, and other staff trained to work with psychiatric patients; individualized activity therapies that are not primarily recreational or diversionary; family counseling (the primary purpose of which is treatment of the individual's condition); patient training and education (to the extent that training and educational activities are closely and clearly related to individual's care and treatment); diagnostic services; and such other items and services (excluding meals and transportation) that are reasonable and necessary for the diagnosis or active treatment of the individual's condition, reasonably expected to improve or maintain the individual's condition and functional level and to prevent relapse or hospitalization, and furnished pursuant to such guidelines relating to frequency and duration of services in accordance with a physician certification and plan of treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure

TAGS: outpatient primary recreational educational psychologists improve weekly minimum mental relating skills authorized patient closely reasonable necessary condition physician activities separately maintain extent contiguous physicians trained individualized qualified health professionals diagnostic prevent group addition furnished education meals procedure items reasonably relapse therapies staff purpose treatment state include individual functional certification pursuant intensive clearly diagnosis psychiatric duration active counseling guidelines opioid social family primarily level frequency training accordance activity therapy occupational expected requiring
Short DescriptionInten outpt svs,min 9 pr 7 d
HCPCS Action Code N - No maintenance for this code
HCPCS Coverage Code C - Carrier judgment
HCPCS Code Added Date January 01, 2024
HCPCS Action Effective Date January 01, 2024
HCPCS Pricing Indicator Code 13 - Price established by carriers (e.G., not otherwise classified, individual determination, carrier discretion)
HCPCS Type Of Service Code 1 - Medical care
HCPCS Multiple Pricing Indicator Code A - Not applicable as HCPCS priced under one methodology
HCPCS Anesthesia Base Unit Quantity 0
HCPCS Coverage Issues Manual Reference Section Number

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