G0109 Diab manage trn ind/group
What G0109 is
Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
HCPCS Level II long description, CMS October 2026 file. See the G codes page for the full section.
Medicare payment for G0109 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 0.25 | 0.22 | 0.01 | 0.48 | $16.03 |
| Facility (hospital, ASC) | 0.25 | 0.22 | 0.01 | 0.48 | $16.03 |
National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.
Status: Active - payable under the Physician Fee Schedule. Global period: Global concept does not apply.
Medically Unlikely Edit (MUE)
Medicare caps G0109 at 12 units per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.
Billed with G0109? These codes are bundled into it
G0109 is a Column 1 code in 8 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.
| Column 2 code | Short description | Modifier indicator | |
|---|---|---|---|
36591 | Draw blood off venous device | 0 - no modifier bypass | Check pair |
36592 | Collect blood from picc | 0 - no modifier bypass | Check pair |
96523 | Irrig drug delivery device | 0 - no modifier bypass | Check pair |
97802 | Medical nutrition indiv in | 0 - no modifier bypass | Check pair |
97803 | Med nutrition indiv subseq | 0 - no modifier bypass | Check pair |
97804 | Medical nutrition group | 0 - no modifier bypass | Check pair |
G0270 | Mnt subs tx for change dx | 0 - no modifier bypass | Check pair |
G0271 | Group mnt 2 or more 30 mins | 0 - no modifier bypass | Check pair |
Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.