G9153 — Mapcp demonstration - physician incentive pool
G9153 is a HCPCS Level II code for mapcp demonstration - physician incentive pool. 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 statusR
Restricted coverage. Special coverage instructions apply, and if covered the service is contractor-priced.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of G9153 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1 unit MAI 3 — Date of Service Edit: Clinical · Clinical: CMS Workgroup
- outpatient
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for G9153
- Long descriptor
- Mapcp demonstration - physician incentive pool
- Short descriptor
- Mapcp demo physician
- Added
- July 1, 2011
- 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 G9153
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9153 is not quite right, the correct code is very often within a few positions of it.
- G9140Frontier extended stay clinic demonstration; for a patient stay in a clinic approved for the cms demonstration project; the following measures should be present: the stay must be equal to or greater than 4 hours; weather or other conditions must prevent transfer or the case falls into a category of monitoring and observation cases that are permitted by the rules of the demonstration; there is a maximum frontier extended stay clinic (fesc) visit of 48 hours, except in the case when weather or other conditions prevent transfer; payment is made on each period up to 4 hours, after the first 4 hours
- G9143Warfarin responsiveness testing by genetic technique using any method, any number of specimen(s)
- G9147Outpatient intravenous insulin treatment (oivit) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (uun); and/or, arterial, venous or capillary glucose; and/or potassium concentration
- G9148National committee for quality assurance - level 1 medical home
- G9149National committee for quality assurance - level 2 medical home
- G9150National committee for quality assurance - level 3 medical home
- G9151Mapcp demonstration - state provided services
- G9152Mapcp demonstration - community health teams
- G9156Evaluation for wheelchair requiring face to face visit with physician
- G9157Transesophageal doppler measurement of cardiac output (including probe placement, image acquisition, and interpretation per course of treatment) for monitoring purposes
- G9158Motor speech functional limitation, discharge status, at discharge from therapy or to end reportingterminated
- G9159Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervalsterminated
- G9160Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reportingterminated
- G9161Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reportingterminated
- G9162Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervalsterminated
- G9163Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge or to end reportingterminated
Questions about G9153
What is HCPCS code G9153?
G9153 is a HCPCS Level II code for mapcp demonstration - physician incentive pool. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9153?
The CMS HCPCS file marks G9153 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 G9153 paid under the physician fee schedule?
G9153 carries PFS status code R. Restricted coverage. Special coverage instructions apply, and if covered the service is contractor-priced.