HCPCS G0152: Occupational Therapy in Home Health or Hospice

Commercial payers pay $69 on average nationally for this procedure.

HCPCS Level II code G0152 describes services performed by a qualified occupational therapist in the home health or hospice setting, billed in 15-minute units for direct occupational therapy evaluation and treatment delivered in the patient’s residence; this code represents occupational therapy service time and is used when documenting and billing time-based skilled OT interventions provided in-home or in hospice care.

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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.

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HCPCS G0152: Occupational Therapy in Home Health or Hospice

Commercial payers pay $69 on average nationally for this procedure.

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.

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.

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.

Related Modifiers

9 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
54	Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…	- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
225X00000X	Occupational Therapist	An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for O…
225XE0001X	Environmental Modification Occupational Therapist	Occupational therapy practitioners are experts at identifying the cause of difficulties in performance of activities of daily living and instrumental …
225XF0002X	Feeding, Eating & Swallowing Occupational Therapist	Occupational therapists provide interventions to clients of all ages with feeding, eating and swallowing difficulties. Occupational therapists provid…
2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the populat…
224P00000X	Prosthetist	A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained…
225XM0800X	Mental Health Occupational Therapist	Occupational therapists provide treatment for people recovering from a mental or physical illness to regain their independence and stability and to en…
347D00000X	Train	An organization or business licensed to provide passenger train service, including light rail, subway, and traditional services.
251V00000X	Voluntary or Charitable Agency	Agencies · Voluntary or Charitable

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
E11.42	Type 2 diabetes mellitus with diabetic polyneuropathy
E11.9	Type 2 diabetes mellitus without complications
F01.50	Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.90	Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
G43.XX
G47.33	Obstructive sleep apnea (adult) (pediatric)
G81.90	Hemiplegia, unspecified affecting unspecified side
I50.9	Heart failure, unspecified
I69.398	Other sequelae of cerebral infarction
M16.11	Unilateral primary osteoarthritis, right hip

Showing 1–10 of 26

Related Payer Policy Updates

Specialty: Gastroenterology1 / 3

10 rows

Policy	Payer	Effective Date
Esophagogastroduodenoscopy (EGD) Coverage Policy	evicore	2026-11-05
Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)	univerahealthcare	2026-10-15
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing	Oscar Health	2026-10-01
Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease	Oscar Health	2026-10-01
Pancreatic Enzyme Testing for Acute Pancreatitis	Oscar Health	2026-10-01
Helicobacter pylori Testing	Oscar Health	2026-10-01
Celiac Disease Testing	Oscar Health	2026-10-01
Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease	Oscar Health	2026-10-01
Colorectal Cancer Screening	Blue Cross Blue Shield - New Mexico	2026-09-04
Pancreatic Enzyme Testing for Acute Pancreatitis	Blue Cross Blue Shield - New Mexico	2026-09-04

HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Administration of Influenza Virus Vaccine

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 PrEP Drug for HIV Prevention

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

HCPCS G0013: Individual PrEP Counseling by Clinical Staff

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, Person-Centered Assessment

Showing 1–10 of 1996

Frequently Asked Questions

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.

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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.

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Clinical & Coding Specifications

Clinical Context

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.

Related Modifiers

9 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
54	Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…	- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
225X00000X	Occupational Therapist	An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for O…
225XE0001X	Environmental Modification Occupational Therapist	Occupational therapy practitioners are experts at identifying the cause of difficulties in performance of activities of daily living and instrumental …
225XF0002X	Feeding, Eating & Swallowing Occupational Therapist	Occupational therapists provide interventions to clients of all ages with feeding, eating and swallowing difficulties. Occupational therapists provid…
2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	A preventive medicine physician who specializes in preventive medicine/occupational-environmental medicine, which is focused on protecting the populat…
224P00000X	Prosthetist	A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained…
225XM0800X	Mental Health Occupational Therapist	Occupational therapists provide treatment for people recovering from a mental or physical illness to regain their independence and stability and to en…
347D00000X	Train	An organization or business licensed to provide passenger train service, including light rail, subway, and traditional services.
251V00000X	Voluntary or Charitable Agency	Agencies · Voluntary or Charitable

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
E11.42	Type 2 diabetes mellitus with diabetic polyneuropathy
E11.9	Type 2 diabetes mellitus without complications
F01.50	Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.90	Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
G43.XX
G47.33	Obstructive sleep apnea (adult) (pediatric)
G81.90	Hemiplegia, unspecified affecting unspecified side
I50.9	Heart failure, unspecified
I69.398	Other sequelae of cerebral infarction
M16.11	Unilateral primary osteoarthritis, right hip

Showing 1–10 of 26

Related Payer Policy Updates

Specialty: Gastroenterology1 / 3

10 rows

Policy	Payer	Effective Date
Esophagogastroduodenoscopy (EGD) Coverage Policy	evicore	2026-11-05
Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)	univerahealthcare	2026-10-15
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing	Oscar Health	2026-10-01
Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease	Oscar Health	2026-10-01
Pancreatic Enzyme Testing for Acute Pancreatitis	Oscar Health	2026-10-01
Helicobacter pylori Testing	Oscar Health	2026-10-01
Celiac Disease Testing	Oscar Health	2026-10-01
Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease	Oscar Health	2026-10-01
Colorectal Cancer Screening	Blue Cross Blue Shield - New Mexico	2026-09-04
Pancreatic Enzyme Testing for Acute Pancreatitis	Blue Cross Blue Shield - New Mexico	2026-09-04

HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Administration of Influenza Virus Vaccine

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 PrEP Drug for HIV Prevention

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

HCPCS G0013: Individual PrEP Counseling by Clinical Staff

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, Person-Centered Assessment

Showing 1–10 of 1996

Frequently Asked Questions

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

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National Reimbursement Benchmarks

OpenPayer

HCPCS G0152: Occupational Therapy in Home Health or Hospice

Sign up for hcpcs G0152 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

HCPCS G0152: Occupational Therapy in Home Health or Hospice

Sign up for hcpcs G0152 policy alerts

National Reimbursement Benchmarks

HCPCS G0152: Occupational Therapy in Home Health or Hospice

Sign up for hcpcs G0152 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does HCPCS code G0152 represent?

What documentation is required when billing G0152?

When is it appropriate to use G0152 for a patient with migraines?

Can G0152 be billed with CPT 97140 for manual therapy?

Which payers are listed as covering G0152 and do payer rules vary?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What does HCPCS code G0152 represent?

What documentation is required when billing G0152?

When is it appropriate to use G0152 for a patient with migraines?

Can G0152 be billed with CPT 97140 for manual therapy?

Which payers are listed as covering G0152 and do payer rules vary?

References