G0537
Risk ascvd tst once pr 12 mo
Behavioral therapy for atherosclerotic cardiovascular disease risk assessment, up to 15 minutes. Implemented in 2025; pairs naturally with the AWV. Once per 12 months per beneficiary.
Published by RVUDoc. Numeric data: CMS RVU26C, effective 2026-07-01. Page updated 2026-09-23. Calculation limits and editorial policy.
Fee-schedule estimate before claim adjustments. Coverage, setting and payer rules still apply.
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
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.
Related codes
These include alternative services and possible add-ons. Listing codes together does not establish that they can be billed together; check the applicable edits and payer policy.
See what G0537 adds to your year
Add it to the wRVU calculator with your own volume, or paste a note and let the chart audit check your coding.