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    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0238-therapeutic-respiratory-improvement-one-on-one
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    HCPCS G0238: Therapeutic Respiratory Procedure, 15-Minute Unit

    Medicare pays $12 and commercial payers pay $17 on average nationally for this procedure.

    HCPCS Level II code G0238 describes one-on-one, face-to-face therapeutic procedures to improve respiratory function, billed in 15-minute increments and including patient monitoring; service type is therapeutic respiratory therapy typically performed in outpatient clinic, pulmonary rehabilitation, or home health 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

    Medicare's mean rate of $11.8 sits well below BUCA's average commercial mean of $17.2, indicating Medicare pays roughly $5.4 less on average for G0238 than this commercial benchmark. That gap highlights a meaningful separation between federal program levels and a subset of commercial contracts represented by BUCA.

    Dispersion (P75−P25) varies across payers: Aetna's spread is $8.0, Blue Cross Blue Shield's is $6.9, Cigna's is $6.0, UnitedHealth Group's is $9.0, and BUCA's is $7.4. UnitedHealth Group exhibits the widest interquartile spread at $9.0, suggesting greater variability in mid-to-upper commercial payments, while Cigna is the tightest at $6.0, indicating more consistency around its central rates.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old male with a history of chronic obstructive pulmonary disease (J44.9) and recent acute exacerbation (J44.1) is referred to outpatient respiratory therapy following hospital discharge for persistent dyspnea and ineffective cough. The patient attends a one-on-one therapeutic respiratory session billed with G0238 to receive airway clearance techniques, incentive spirometry optimization, and individualized instruction on breathing strategies. The clinical workflow begins with a respiratory therapist or pulmonary disease physician performing an initial assessment (vital signs, oxygen saturation, auscultation, and cough effectiveness). The therapist delivers face-to-face therapeutic procedures in 15-minute increments, including direct monitoring of response (work of breathing, oxygen saturation, and bronchial secretions) and adjustment of technique. Documentation includes start and stop times for each 15-minute unit, the specific interventions performed, patient tolerance and response, and any changes to oxygen or adjunctive devices. If the patient requires additional units, repeated 15-minute charges are appended. Coordination with the treating pulmonologist occurs for medication adjustments or further diagnostic evaluation if needed. Typical sites of service include outpatient respiratory therapy clinics, hospital-based outpatient departments, and skilled nursing facility therapy areas where individualized, face-to-face respiratory therapeutic procedures are delivered.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑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…
    53Modifier 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…
    22Modifier –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…
    26Modifier 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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RP1001XPulmonary Disease PhysicianAn internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational an…
    227900000XRegistered Respiratory TherapistA Registered Respiratory Therapist (RRT) is an advanced therapist who has passed standardized written and clinical simulation examinations administere…
    2278C0205XCritical Care Certified Respiratory TherapistRespiratory emergencies are commonplace in the treatment of critical care patients. Included in the assessment measurements conducted by the respirat…
    332BD1200XDialysis Equipment & Supplies (DME)Suppliers · Durable Medical Equipment & Medical Supplies
    364SI0800XInformatics Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    1223P0300XPeriodonticsThat specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the tee…
    1710I1003XIndependent Duty Medical TechniciansAn Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatmen…
    3418M1110XMilitary or U.S. Coast Guard Ground Transport AmbulanceVehicle and staff for patient emergency or non-emergency ground transport. Includes traditional ambulances as well as ambulance buses.

    Related ICD-10-CM Codes

    33 rows

    ICD-10-CM CodeDescription
    E11.65Type 2 diabetes mellitus with hyperglycemia
    E86.0Dehydration
    F17.210Nicotine dependence, cigarettes, uncomplicated
    G47.33Obstructive sleep apnea (adult) (pediatric)
    I50.21Acute systolic (congestive) heart failure
    I50.9Heart failure, unspecified
    J18.9Pneumonia, unspecified organism
    J20.9Acute bronchitis, unspecified
    J40Bronchitis, not specified as acute or chronic
    J43.0Unilateral pulmonary emphysema [MacLeod's syndrome]

    Showing 1–10 of 33

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    7 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01
    Celiac Disease TestingOscar Health2026-10-01

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    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

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    Frequently Asked Questions

    References

    1. 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. 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. 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.

    G0237Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)Closely related; used when the primary focus is respiratory muscle strengthening rather than other respiratory function improvement.
    G0239Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)Group therapy counterpart when the same interventions are delivered to two or more patients simultaneously.
    94625Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; without continuous oximetry monitoring (per session)Represents comprehensive pulmonary rehabilitation sessions billed per session rather than per 15-minute unit; used in broader rehabilitation programs.
    94626Physician or other qualified health care professional services for outpatient pulmonary rehabilitation; with continuous oximetry monitoring (per session)Used when continuous oximetry monitoring is provided during a pulmonary rehabilitation session and billed per session.