HCPCS G0237: Respiratory Muscle Strengthening, 15-Min Intervals
Medicare pays $13 and commercial payers pay $17 on average nationally for this procedure.
HCPCS Level II code G0237 describes face-to-face, one-on-one therapeutic procedures to increase strength or endurance of respiratory muscles, billed in 15-minute increments and including monitoring; typical service type is respiratory muscle strengthening therapy and the typical site of service is outpatient or clinic-based pulmonary rehabilitation/respiratory therapy settings.
For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.
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National Reimbursement Benchmarks
National means place Medicare and BUCA relatively close on average for G0237: Medicare’s mean is $13.3 versus BUCA’s average commercial mean of $17.4, so BUCA sits about $4.1 higher than Medicare on mean reimbursement. Blue Cross Blue Shield and Cigna pull averages upward with higher mean values and long upper tails, while Aetna and UnitedHealth Group cluster nearer to the lower-middle of the national spectrum.
Examining dispersion via the interquartile range (P75 minus P25) highlights where rates concentrate: Blue Cross Blue Shield has a range of $9.0, Cigna shows a wide spread of $6.3, UnitedHealth Group’s IQR is $9.5, Aetna is tight at $8.0, and BUCA’s IQR is $8.5. UnitedHealth Group and Blue Cross Blue Shield exhibit the widest spread among payers listed, indicating greater variability in commercially negotiated mid-to-upper rates, while Aetna is among the tighter payers in terms of middle‑50% concentration.