G0166 Extrnl counterpulse, per tx
What G0166 is
External counterpulsation, per treatment session
HCPCS Level II long description, CMS October 2026 file. See the G codes page for the full section.
Medicare payment for G0166 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 0.00 | 3.04 | 0.04 | 3.08 | $102.87 |
| Facility (hospital, ASC) | 0.00 | 3.04 | 0.04 | 3.08 | $102.87 |
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 G0166 at 2 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 G0166? These codes are bundled into it
G0166 is a Column 1 code in 19 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 | |
|---|---|---|---|
0903T | Ecg alg 12 lead reduced i&r | 1 - modifier may bypass | Check pair |
0904T | Ecg alg 12 ld rdcd trcg only | 1 - modifier may bypass | Check pair |
0905T | Ecg alg 12 ld rdcd i&r only | 1 - modifier may bypass | Check pair |
36591 | Draw blood off venous device | 0 - no modifier bypass | Check pair |
36592 | Collect blood from picc | 0 - no modifier bypass | Check pair |
92971 | Cardioassist external | 0 - no modifier bypass | Check pair |
93000 | Electrocardiogram complete | 1 - modifier may bypass | Check pair |
93005 | Electrocardiogram tracing | 1 - modifier may bypass | Check pair |
93010 | Electrocardiogram report | 1 - modifier may bypass | Check pair |
93040 | Rhythm ecg with report | 0 - no modifier bypass | Check pair |
93041 | Rhythm ecg tracing | 0 - no modifier bypass | Check pair |
93042 | Rhythm ecg report | 0 - no modifier bypass | Check pair |
93701 | Bioimpedance cv analysis | 0 - no modifier bypass | Check pair |
93922 | Upr/l xtremity art 2 levels | 1 - modifier may bypass | Check pair |
93923 | Upr/lxtr art stdy 3+ lvls | 1 - modifier may bypass | Check pair |
93924 | Lwr xtr vasc stdy bilat | 0 - no modifier bypass | Check pair |
96523 | Irrig drug delivery device | 0 - no modifier bypass | Check pair |
97016 | Vasopneumatic device therapy | 0 - no modifier bypass | Check pair |
99211 | Off/op est may x req phy/qhp | 1 - modifier may 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.