Question 1

What is HCPCS code G0384?

Accepted Answer

HCPCS code G0384 is "Lev 5 hosp type b ed visit". Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 cfr 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)

Question 2

What category is G0384 in?

Accepted Answer

G0384 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0384?

Accepted Answer

Use G0384 when billing for lev 5 hosp type b ed visit. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G0384 covered by Medicare?

Accepted Answer

Coverage for G0384 (Lev 5 hosp type b ed visit) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G0384?

Accepted Answer

Documentation for G0384 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).