`G0245` Initial foot exam pt lops

What G0245 is

Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education

HCPCS Level II long description, CMS October 2026 file. See the G codes page for the full section.

Medicare payment for G0245 (CY2026)

	Work RVU	Practice expense RVU	Malpractice RVU	Total	Medicare rate
Non-facility (office)	0.86	1.06	0.04	1.96	$65.47
Facility (hospital, ASC)	0.86	0.14	0.04	1.04	$34.74

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.

Adjust for a Medicare locality:

Status: Restricted coverage - payable only in specific circumstances. Global period: Global concept does not apply.

Medically Unlikely Edit (MUE)

Medicare caps G0245 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with G0245? These codes are bundled into it

G0245 is a Column 1 code in 42 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
`0552T`	Low-level laser therapy	0 - no modifier bypass	Check pair
`0936T`	Photobiomodulation ther rta	1 - modifier may bypass	Check pair
`11042`	Dbrdmt subq tis 1st 20sqcm/<	0 - no modifier bypass	Check pair
`11043`	Dbrdmt musc&/fsca 1st 20/<	0 - no modifier bypass	Check pair
`11044`	Dbrdmt bone 1st 20 sq cm/<	0 - no modifier bypass	Check pair
`11055`	Paring/cutg b9 hyprker les 1	0 - no modifier bypass	Check pair
`11056`	Parng/cutg b9 hyprkr les 2-4	0 - no modifier bypass	Check pair
`11057`	Parng/cutg b9 hyprkr les >4	0 - no modifier bypass	Check pair
`11305`	Shave skin lesion 0.5 cm/<	0 - no modifier bypass	Check pair
`11306`	Shave skin lesion 0.6-1.0 cm	0 - no modifier bypass	Check pair
`11307`	Shave skin lesion 1.1-2.0 cm	0 - no modifier bypass	Check pair
`11308`	Shave skin lesion >2.0 cm	0 - no modifier bypass	Check pair
`11420`	Exc h-f-nk-sp b9+marg 0.5/<	1 - modifier may bypass	Check pair
`11421`	Exc h-f-nk-sp b9+marg 0.6-1	1 - modifier may bypass	Check pair
`11422`	Exc h-f-nk-sp b9+marg 1.1-2	1 - modifier may bypass	Check pair
`11423`	Exc h-f-nk-sp b9+marg 2.1-3	1 - modifier may bypass	Check pair
`11424`	Exc h-f-nk-sp b9+marg 3.1-4	1 - modifier may bypass	Check pair
`11426`	Exc h-f-nk-sp b9+marg >4 cm	1 - modifier may bypass	Check pair
`11719`	Trim nail(s) any number	0 - no modifier bypass	Check pair
`11720`	Debride nail 1-5	0 - no modifier bypass	Check pair
`11721`	Debride nail 6 or more	0 - no modifier bypass	Check pair
`11755`	Biopsy nail unit	0 - no modifier bypass	Check pair
`11765`	Wedge excision skn nail fold	0 - no modifier 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
`96523`	Irrig drug delivery device	0 - no modifier bypass	Check pair
`97597`	Dbrdmt opn wnd 1st 20 cm/<	0 - no modifier bypass	Check pair
`97598`	Dbrdmt opn wnd addl 20cm/<	0 - no modifier bypass	Check pair
`97602`	Wound(s) care non-selective	0 - no modifier bypass	Check pair
`97605`	Neg prs wnd ther dme<=50sqcm	0 - no modifier bypass	Check pair

Showing 30 of 42 column 2 codes. Use the pair checker for any specific combination.

G0245 is bundled into these codes

G0245 appears as a Column 2 code in 63 active edits. Reported with one of these Column 1 codes on the same date of service, G0245 is the code that denies.

Column 1 code	Short description
`99202`	Office o/p new sf 15 min	Check pair
`99203`	Office o/p new low 30 min	Check pair
`99204`	Office o/p new mod 45 min	Check pair
`99205`	Office o/p new hi 60 min	Check pair
`99211`	Off/op est may x req phy/qhp	Check pair
`99212`	Office o/p est sf 10 min	Check pair
`99213`	Office o/p est low 20 min	Check pair
`99214`	Office o/p est mod 30 min	Check pair
`99215`	Office o/p est hi 40 min	Check pair
`99221`	1st hosp ip/obs sf/low 40	Check pair
`99222`	1st hosp ip/obs moderate 55	Check pair
`99223`	1st hosp ip/obs high 75	Check pair
`99231`	Sbsq hosp ip/obs sf/low 25	Check pair
`99232`	Sbsq hosp ip/obs moderate 35	Check pair
`99233`	Sbsq hosp ip/obs high 50	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.