| G0 |
Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke |
| G1 |
Most recent urr reading of less than 60 |
| G2 |
Most recent urr reading of 60 to 64.9 |
| G3 |
Most recent urr reading of 65 to 69.9 |
| G4 |
Most recent urr reading of 70 to 74.9 |
| G5 |
Most recent urr reading of 75 or greater |
| G6 |
Esrd patient for whom less than six dialysis sessions have been provided in a month |
| G7 |
Pregnancy resulted from rape or incest or pregnancy certified by physician as life threatening |
| G8 |
Monitored anesthesia care (mac) for deep complex, complicated, or markedly invasive surgical procedure |
| G9 |
Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition |
| GA |
Waiver of liability statement issued as required by payer policy, individual case |
| GB |
Claim being re-submitted for payment because it is no longer covered under a global payment demonstration |
| GC |
This service has been performed in part by a resident under the direction of a teaching physician |
| GD |
Units of service exceeds medically unlikely edit value and represents reasonable and necessary services |
| GE |
This service has been performed by a resident without the presence of a teaching physician under the primary care exception |
| GF |
Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital |
| GG |
Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day |
| GH |
Diagnostic mammogram converted from screening mammogram on same day |
| GJ |
"opt out" physician or practitioner emergency or urgent service |
| GK |
Reasonable and necessary item/service associated with a ga or gz modifier |
| GL |
Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn) |
| GM |
Multiple patients on one ambulance trip |
| GN |
Services delivered under an outpatient speech language pathology plan of care |
| GO |
Services delivered under an outpatient occupational therapy plan of care |
| GP |
Services delivered under an outpatient physical therapy plan of care |
| GQ |
Via asynchronous telecommunications system |
| GR |
This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic, supervised in accordance with va policy |
| GS |
Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level |
| GT |
Via interactive audio and video telecommunication systems |
| GU |
Waiver of liability statement issued as required by payer policy, routine notice |
| GV |
Attending physician not employed or paid under arrangement by the patient's hospice provider |
| GW |
Service not related to the hospice patient's terminal condition |
| GX |
Notice of liability issued, voluntary under payer policy |
| GY |
Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit |
| GZ |
Item or service expected to be denied as not reasonable and necessary |