G0109 HCPCS code: Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
G0109 is the HCPCS Level II code for diabetes outpatient self-management training services, group session (2 or more), per 30 minutes. In 2024 Medicare paid an average of $11.46 per service for G0109 across 42,321 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 12 per day on outpatient hospital claims. Medicare volume rose 16% from 2022 to 2024 (36,603 to 42,321 services). In 2024, about 710 clinicians billed Medicare for G0109 for 4,505 beneficiaries; Florida, Maryland, California accounted for 30% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 11 — Priced using national relative value units (Physician Fee Schedule) |
| BETOS category | Y1 |
| Added | 1998-07-01 |
| Last action effective | 2001-01-01 |
Who bills G0109 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 710 |
| Medicare beneficiaries | 4,505 |
| States with claims | 36 |
| Share of services in top 3 states (Florida, Maryland, California) | 30% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0109, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 36,603 | 4,041 | $15.59 | $11.53 |
| 2023 | 44,318 | 4,646 | $15.30 | $11.45 |
| 2024 | 42,321 | 4,505 | $15.44 | $11.46 |
States with the most G0109 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 6,225 | $11.25 |
| Maryland | 3,311 | $11.52 |
| California | 2,962 | $12.96 |
| North Carolina | 2,244 | $10.78 |
| Illinois | 2,239 | $12.40 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 12 | Nature of Service/Procedure |
| practitioner claims | 12 | Nature of Service/Procedure |
What changed for G0109
- 1998-07-01: G0109 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0109?
G0109 is the HCPCS Level II code for diabetes outpatient self-management training services, group session (2 or more), per 30 minutes. Short descriptor: "Diab manage trn ind/group".
How much does Medicare pay for G0109?
In 2024, the average Medicare payment was $11.46 per service (average allowed $15.44).
Does Medicare cover G0109?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of G0109 can be billed per day?
12 on outpatient hospital claims; 12 on practitioner claims (NCCI medically unlikely edits).
Related G01 codes
- G0101 — Cervical or vaginal cancer screening; pelvic and clinical breast examination
- G0102 — Prostate cancer screening; digital rectal examination
- G0103 — Prostate cancer screening; prostate specific antigen test (PSA)
- G0104 — Colorectal cancer screening; flexible sigmoidoscopy
- G0105 — Colorectal cancer screening; colonoscopy on individual at high risk
- G0106 — Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema
- G0108 — Diabetes outpatient self-management training services, individual, per 30 minutes
- G0117 — Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
- G0118 — Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist
- G0120 — Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema.
- G0121 — Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
- G0122 — Colorectal cancer screening; barium enema
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under G0109
- Watch G0109 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0109
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.