G0038 — Clinician determines patient does not require referral
G0038 is a HCPCS Level II code for clinician determines patient does not require referral. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusM
Measurement code. Used for reporting purposes only; never paid.
Global period: XXX
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The CMS record for G0038
- Long descriptor
- Clinician determines patient does not require referral
- Short descriptor
- Clin pt no ref
- Added
- January 1, 2022
- BETOS
- Z2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to G0038
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G0038 is not quite right, the correct code is very often within a few positions of it.
- G0030Patient screened for tobacco use and received tobacco cessation intervention during the measurement period or in the six months prior to the measurement period (counseling, pharmacotherapy, or both), if identified as a tobacco user
- G0031Palliative care services given to patient any time during the measurement period
- G0032Two or more antipsychotic prescriptions ordered for patients who had a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder on or between january 1 of the year prior to the measurement period and the index prescription start date (ipsd) for antipsychotics
- G0033Two or more benzodiazepine prescriptions ordered for patients who had a diagnosis of seizure disorders, rapid eye movement sleep behavior disorder, benzodiazepine withdrawal, ethanol withdrawal, or severe generalized anxiety disorder on or between january 1 of the year prior to the measurement period and the ipsd for benzodiazepines
- G0034Patients receiving palliative care during the measurement period
- G0035Patient has any emergency department encounter during the performance period with place of service indicator 23
- G0036Patient or care partner decline assessment
- G0037On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available
- G0039Patient not referred, reason not otherwise specified
- G0040Patient already receiving physical/occupational/speech/recreational therapy during the measurement period
- G0041Patient and/or care partner decline referral
- G0042Referral to physical, occupational, speech, or recreational therapy
- G0043Patients with mechanical prosthetic heart valve
- G0044Patients with moderate or severe mitral stenosis
- G0045Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention
- G0046Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention
Questions about G0038
What is HCPCS code G0038?
G0038 is a HCPCS Level II code for clinician determines patient does not require referral. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G0038?
The CMS HCPCS file marks G0038 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G0038 paid under the physician fee schedule?
G0038 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.