G0537 Risk ascvd tst once pr 12 mo
What G0537 is
Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 months
HCPCS Level II long description, CMS October 2026 file. See the G codes page for the full section.
Medicare payment for G0537 (CY2026)
| Work RVU | Practice expense RVU | Malpractice RVU | Total | Medicare rate | |
|---|---|---|---|---|---|
| Non-facility (office) | 0.18 | 0.41 | 0.01 | 0.60 | $20.04 |
| Facility (hospital, ASC) | 0.18 | 0.05 | 0.01 | 0.24 | $8.02 |
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 G0537 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.
NCCI edits
No active practitioner PTP edit in the 2026 Q4 table lists this code as a column 1 or column 2 code. Check a specific pair in the NCCI pair checker.
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.