Question 1

What is HCPCS code G0428?

Accepted Answer

HCPCS code G0428 is "Collagen meniscus implant". Collagen meniscus implant procedure for filling meniscal defects (e.g., cmi, collagen scaffold, menaflex)

Question 2

What category is G0428 in?

Accepted Answer

G0428 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G0428?

Accepted Answer

Use G0428 when billing for collagen meniscus implant. 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 G0428 covered by Medicare?

Accepted Answer

Coverage for G0428 (Collagen meniscus implant) 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 G0428?

Accepted Answer

Documentation for G0428 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).