HCPCS G0166 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Procedures / Professional Services • Miscellaneous Diagnostic and Therapeutic Services |
| Complexity Level | Low |
National average reimbursement for HCPCS G0166 by major payers:
$148.16
$167.08
$131.50
$114.16
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS G0166 | ||||||
United | G0166 | $149.88 | 1386624542 - DALJIT MUTTIANA | 760593600 - (TX) CARDIOVASCULAR INSTITUTE, PA | TX | Cardiovascular Disease Physician (207RC0000X) |
United | G0166 | $225.78 | 1861468449 - SALIM MATHEW | 20497927 - MASS GENERAL BRIGHAM INCORPORATED | TX | Interventional Cardiology Physician (207RI0011X) |
United | G0166 | $235.05 | 1083875181 - NANDINI NAIR | 251857035 | TX | Advanced Heart Failure and Transplant Cardiology Physician (207RA0001X) |
United | G0166 | $88.66 | 1720424542 - APURVA PATEL | 813081687 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | G0166 | $317.26 | 1861470023 - RUDY HADDAD | 752600873 - (TX) SHANNON CLINIC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | G0166 | $200.11 | 1104864800 - RICHARD LANGE | 752668018 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | G0166 | $150.86 | 1760417026 - AMIT GUTTIGOLI | 752390285 - (TX) NORTH TEXAS CARDIOVASCULAR ASS | TX | Cardiovascular Disease Physician (207RC0000X) |
United | G0166 | $109.51 | 1437253481 - NIKHIL JOSHI | 821022091 - (TX) EVEREST SPECIALTY GROUP PLLC | TX | Interventional Cardiology Physician (207RI0011X) |
United | G0166 | $177.52 | 1053674408 - YASIR ABDUL GHAFFAR | 262400924 | TX | Interventional Cardiology Physician (207RI0011X) |
United | G0166 | $179.39 | 1083632293 - SCOTT GREENBERG | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Clinical Cardiac Electrophysiology Physician (207RC0001X) |
United | G0166 | $239.22 | 1528121043 - ELIZABETH HOLPER | 810233121 - ST PETERS HEALTH | TX | Interventional Cardiology Physician (207RI0011X) |
United | G0166 | $104.30 | 1750355103 - JASON FINKELSTEIN | 752694558 - ADVANCED HEART CARE, P. A. | TX | Interventional Cardiology Physician (207RI0011X) |
United | G0166 | $239.22 | 1376582460 - UMANG SHAH | 131624096 - MOUNT SINAI HOSPITAL | TX | Cardiovascular Disease Physician (207RC0000X) |
United | G0166 | $118.06 | 1740398577 - MAZEN GANIM | 760565432 - CARDIOVASCULAR ASSOCIATION PLLC | TX | Interventional Cardiology Physician (207RI0011X) |
United | G0166 | $83.44 | 1760443790 - GEORGE MILLER | 462598558 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS G0166 vs. Other Miscellaneous Diagnostic and Therapeutic Services Codes
The HCPCS G0166 code is part of the Procedures / Professional Services services used for Miscellaneous Diagnostic and Therapeutic Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS G0166 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| G0162-HCPCS | Low | Skilled services by a registered nurse (RN) for management and evaluation of the plan of care; each 15 minutes (the patient's underlying condition or complication requires an RN to ensure that essential non-skilled care achieves its purpose in the home health or hospice setting) |
| G0166-HCPCS | Low | External counterpulsation, per treatment session |
| G0168-HCPCS | Low | Wound closure utilizing tissue adhesive(s) only |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0166. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0166 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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