Screening / Counsel · CMS status A
G0537
Risk ascvd tst once pr 12 mo
Behavioral therapy for atherosclerotic cardiovascular disease risk assessment, up to 15 minutes. CMS 2026 wRVU 0.18. Implemented in 2025; pairs naturally with the AWV. Once per 12 months per beneficiary.
Work RVU
0.18
2026 Medicare pays
$20.04
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 0.18 + Practice 0.41 + Malpractice 0.01 = 0.60 total
Work (your effort)Practice expenseMalpractice
Billing guidance for G0537 is locked
- When to use it: the exact clinical situations that support billing G0537
- Documentation checklist: the 7 elements your note needs before submitting
- Common pitfalls: the 6 mistakes that get G0537 downcoded or denied
Start your free 3-month trial →Every new account gets full Pro Max access for 3 months. No card needed.
Common ICD-10 pairings
Z13.6
Payer notes
Medicare implemented G0537 in 2025 and covers it with no patient cost share when billed preventively. Medicare Advantage plans typically follow Medicare rules. Commercial payer coverage is mixed; many do not yet recognize G0537 and expect risk assessment to be embedded inside a preventive E/M. Verify payer-specific coverage before billing commercial. Payers that accept G0537 audit for the actual calculated percentage; a qualitative high, medium, or low rating is not enough.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.