Find policies, billing codes, payers, states, and providers

HCPCS G0152: Occupational Therapy in Home Health or Hospice, 15-Min Units

HCPCS Level II code G0152 represents 15-minute units of occupational therapy provided by a qualified occupational therapist in home health or hospice settings. This code matters nationally as home-based rehabilitative and palliative services expand to meet needs of aging and chronically ill populations; accurate coding of time-based therapy units affects care documentation, care planning, and payment flows across payers. Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of clinical context for using G0152, how the code is used alongside related therapy services, and payer coverage considerations. The publication summarizes common billing practices and benchmarking elements relevant to time-based occupational therapy in home health and hospice. It also outlines policy and coding considerations that affect claims processing and documentation requirements nationally. Data not available in the input for detailed payer-specific rates and utilization patterns is acknowledged where applicable. The content is intended to inform coding, billing, and policy stakeholders about the role and administrative context of G0152 in home-based occupational therapy delivery.

Customize your policy alerts

Sign up for hcpcs G0152 policy alerts

Get alerted when payer policies referencing G0152 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

HCPCS Level II code G0152 describes services performed by a qualified occupational therapist in the home health or hospice setting, each 15 minutes. The service type is occupational therapy delivered in a home health or hospice care environment. The typical site of service is the patient's home or hospice residence.

National Reimbursement Benchmarks

National commercial reimbursement for HCPCS G0152 centers on BUCA as the average commercial benchmark at $68.5, with payer-specific variation around that figure. Blue Cross Blue Shield (BCBS) shows high central tendency but broad dispersion, while Aetna and Cigna cluster more tightly near their medians. UnitedHealth Group displays a distinct distribution with a median of $0 and a high maximum, indicating a skewed pattern of coverage for this code.

Measuring dispersion by P75 minus P25: Blue Cross Blue Shield has the widest interquartile spread at $8.4 (P75 $97.6 minus P25 $88.4), indicating more variability in commercial rates; BUCA’s IQR is $3.3 (P75 $69.9 minus P25 $64.6), showing relatively modest spread around the $68.5 mean; Aetna’s IQR is $0 (P75 $23.0 minus P25 $23.0) and Cigna’s IQR is $0 (P75 $75.7 minus P25 $75.7), reflecting very tight clustering, while UnitedHealth Group’s IQR is $0 (P75 $0.0 minus P25 $0.0) but with a large max of $61.4, indicating concentrated low-to-none median payments with some high outliers.

Explore openpayer tools

View all tools

Find policies, billing codes, payers, states, and providers

HCPCS G0152: Occupational Therapy in Home Health or Hospice, 15-Min Units

Customize your policy alerts

Sign up for hcpcs G0152 policy alerts

Get alerted when payer policies referencing G0152 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 54-year-old female homebound patient with a history of chronic migraine disorder (G43.XX) receives skilled occupational therapy visits in the home health setting. The patient experiences frequent migraine attacks with associated sensitivity to light and neck and upper-extremity functional limitations that interfere with activities of daily living (ADLs) such as meal preparation, grooming, and instrumental ADLs. A qualified occupational therapist conducts focused, skilled therapeutic sessions in the patient’s home, billed in 15-minute increments using G0152. The therapist evaluates posture, upper-quadrant range of motion and pain-related functional barriers; provides manual therapeutic interventions, task-specific training, ergonomic/environmental modification recommendations, adaptation of ADL techniques, and caregiver education. Documentation includes time spent in hands-on skilled treatment, objective measures of function or pain, the skilled rationale linking interventions to the migraine-related functional deficits, progress toward measurable goals, and any safety or environmental modification recommendations prior to billing each 15-minute unit of G0152. Typical workflow: initial home visit evaluation (assessment, baseline function, plan), subsequent skilled treatment visits documented by time and skilled content, periodic reassessment, and communication with the referring physician and home health agency for plan updates and medical necessity justification.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services	Use when the occupational therapist provides services substantially greater than typically required, documented with justification for unusually complex or prolonged skilled intervention for migraine-related functional impairment.
`23`	Unusual Anesthesia	Rare for this code; use only if unexpected general anesthesia is required during a home service (extremely uncommon) and appropriately documented.
`26`	Professional Component	Use when billing only the therapist's professional component separate from technical/agency charge (applies if split billing arrangement exists).
`52`	Reduced Services	Use when the service provided is partially reduced or discontinued and documentation supports medical necessity for reduced service time or scope.
`53`	Discontinued Procedure	Use if the session was started but discontinued for patient safety or medical reasons (e.g., acute migraine episode preventing completion).
`54`	Surgical Care Only	Not typical for `G0152`; would apply only if occupational therapist bills portion of post-surgical care under specific arrangements.
`56`	Pre-operative Care Only	Not typical; include only if billing rules require separation of pre-operative OT services.
`62`	Two Surgeons	Rare for OT services; use only per payer guidance when two qualified providers share care responsibilities qualifying for this modifier.
`78`	Return to OR for Related Procedure	Not applicable to routine OT; include only if service directly relates to reopening a prior procedure as defined by payer rules.
`AS`	Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Medicare beneficiary	Use when services are furnished by an eligible non-physician practitioner under applicable supervision rules and payer requires `AS` reporting.
`CO`	Routine Services	Use where payer requires identification of routine care services per contract (payer-specific usage).
`CQ`	Service Delivered Under an OT Assistant's Direction	Use when portions of care are delivered by an occupational therapy assistant under the supervision of a qualified OT and payer requires this modifier.
`FX`	Single Foot/Ankle Service	Use only if payer requires laterality modifiers for specific body part—rare for `G0152` but may be used if documentation supports single-limb focus.
`G0`	Telehealth—Emergency Use	Use if service otherwise reportable via telehealth during an emergency waiver and payer accepts `G0152` remotely.

Taxonomy Code	Specialty	Notes
`225X00000X`	Occupational Therapist	Primary provider performing skilled home health occupational therapy interventions billed with `G0152`.
`225XE0001X`	Environmental Modification Occupational Therapist	OT specialty focused on home and environmental adaptation recommendations and installation guidance relevant to improving ADLs in migraine patients.
`225XF0002X`	Feeding, Eating & Swallowing Occupational Therapist	Relevant if migraine-related functional deficits impact feeding, mealtime strategies, or oropharyngeal management during therapy sessions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G43.XX`	Migraines (all related codes)	Primary diagnosis category indicating migraine disorder; justifies skilled OT when migraine attacks produce functional impairments in ADLs, light sensitivity management, neck/upper-extremity dysfunction, or safety concerns in the home setting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97140`	Manual Therapy Techniques (e.g., mobilization/manipulation, manual lymphatic drainage), 1 or more regions, each 15 minutes	Often performed by an occupational therapist as a hands-on component to address neck and upper-quadrant musculoskeletal contributors to migraine symptoms; can be billed in conjunction with `G0152` where payer rules permit separate CPT reporting for manual therapy.

HCPCS G9490: Home Visit Assessment for Non-Homebound Patients

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Influenza Virus Vaccine Administration

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling and HIV Risk Assessment

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration for Social Determinants of Health

Showing 1–10 of 1996

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`22`	Increased Procedural Services	Use when the occupational therapist provides services substantially greater than typically required, documented with justification for unusually complex or prolonged skilled intervention for migraine-related functional impairment.
`23`	Unusual Anesthesia	Rare for this code; use only if unexpected general anesthesia is required during a home service (extremely uncommon) and appropriately documented.
`26`	Professional Component	Use when billing only the therapist's professional component separate from technical/agency charge (applies if split billing arrangement exists).
`52`	Reduced Services	Use when the service provided is partially reduced or discontinued and documentation supports medical necessity for reduced service time or scope.
`53`	Discontinued Procedure	Use if the session was started but discontinued for patient safety or medical reasons (e.g., acute migraine episode preventing completion).
`54`	Surgical Care Only	Not typical for `G0152`; would apply only if occupational therapist bills portion of post-surgical care under specific arrangements.
`56`	Pre-operative Care Only	Not typical; include only if billing rules require separation of pre-operative OT services.
`62`	Two Surgeons	Rare for OT services; use only per payer guidance when two qualified providers share care responsibilities qualifying for this modifier.
`78`	Return to OR for Related Procedure	Not applicable to routine OT; include only if service directly relates to reopening a prior procedure as defined by payer rules.
`AS`	Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Medicare beneficiary	Use when services are furnished by an eligible non-physician practitioner under applicable supervision rules and payer requires `AS` reporting.
`CO`	Routine Services	Use where payer requires identification of routine care services per contract (payer-specific usage).
`CQ`	Service Delivered Under an OT Assistant's Direction	Use when portions of care are delivered by an occupational therapy assistant under the supervision of a qualified OT and payer requires this modifier.
`FX`	Single Foot/Ankle Service	Use only if payer requires laterality modifiers for specific body part—rare for `G0152` but may be used if documentation supports single-limb focus.
`G0`	Telehealth—Emergency Use	Use if service otherwise reportable via telehealth during an emergency waiver and payer accepts `G0152` remotely.

Taxonomy Code	Specialty	Notes
`225X00000X`	Occupational Therapist	Primary provider performing skilled home health occupational therapy interventions billed with `G0152`.
`225XE0001X`	Environmental Modification Occupational Therapist	OT specialty focused on home and environmental adaptation recommendations and installation guidance relevant to improving ADLs in migraine patients.
`225XF0002X`	Feeding, Eating & Swallowing Occupational Therapist	Relevant if migraine-related functional deficits impact feeding, mealtime strategies, or oropharyngeal management during therapy sessions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G43.XX`	Migraines (all related codes)	Primary diagnosis category indicating migraine disorder; justifies skilled OT when migraine attacks produce functional impairments in ADLs, light sensitivity management, neck/upper-extremity dysfunction, or safety concerns in the home setting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97140`	Manual Therapy Techniques (e.g., mobilization/manipulation, manual lymphatic drainage), 1 or more regions, each 15 minutes	Often performed by an occupational therapist as a hands-on component to address neck and upper-quadrant musculoskeletal contributors to migraine symptoms; can be billed in conjunction with `G0152` where payer rules permit separate CPT reporting for manual therapy.

HCPCS G9490: Home Visit Assessment for Non-Homebound Patients

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Influenza Virus Vaccine Administration

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling and HIV Risk Assessment

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration for Social Determinants of Health

Showing 1–10 of 1996

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

HCPCS G0152: Occupational Therapy in Home Health or Hospice, 15-Min Units

Sign up for hcpcs G0152 policy alerts

Billing Code Overview

National Reimbursement Benchmarks

OpenPayer

HCPCS G0152: Occupational Therapy in Home Health or Hospice, 15-Min Units

Sign up for hcpcs G0152 policy alerts

Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References