External Counterpulsation Billing (G0166)

National Government Services has discovered providers are billing invalid places of services for G0166 (External Counterpulsation, per treatment session) as per The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Section 50.6 (Physician Fee Schedule Payment Policy Indicator File Record Layout). When the professional component/technical component indicator equates to five, the procedures are only payable when provided in a nonhospital setting (i.e., 11 (office) and 49 (independent clinic). Procedure code G0166 will be denied if billed with place of service 19 or 22.

Please also refer to the External Counterpulsation National Coverage Determination and billing information for additional details on this service: 

• CMS IOM Publication 100-03, Medicare National Coverage Determination Manual, Chapter 1, Section 20.20
• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 32, Section 130

Posted 8/1/2019