G0117 HCPCS code: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist
G0117 is the HCPCS Level II code for glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist. In 2024 Medicare paid an average of $39.77 per service for G0117 across 27 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 1 per day on outpatient hospital claims. Medicare volume fell 66% from 2022 to 2024 (79 to 27 services). In 2024, about 12 clinicians billed Medicare for G0117 for 27 beneficiaries.
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 | T2D |
| Added | 2002-01-01 |
| Last action effective | 2003-10-01 |
Who bills G0117 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 12 |
| Medicare beneficiaries | 27 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0117, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 79 | 79 | $56.71 | $36.26 |
| 2023 | 27 | 27 | $59.46 | $34.22 |
| 2024 | 27 | 27 | $57.60 | $39.77 |
States with the most G0117 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Louisiana | 14 | $44.16 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Code Descriptor / CPT Instruction |
| practitioner claims | 1 | Code Descriptor / CPT Instruction |
Medicare policy articles for this code
- A53495: Glaucoma Screening (Palmetto GBA (MAC - Part B))
Covered diagnoses (1 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| Z13.5 | Encounter for screening for eye and ear disorders | 1 |
What changed for G0117
- 2002-01-01: G0117 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 G0117?
G0117 is the HCPCS Level II code for glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist. Short descriptor: "Glaucoma scrn hgh risk direc".
How much does Medicare pay for G0117?
In 2024, the average Medicare payment was $39.77 per service (average allowed $57.60).
Does Medicare cover G0117?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for G0117?
Medicare policy articles that cite G0117 list 1 covered ICD-10-CM diagnosis codes across 1 article. The most cited include Z13.5 (Encounter for screening for eye and ear disorders). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of G0117 can be billed per day?
1 on outpatient hospital claims; 1 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
- G0109 — Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes
- 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 G0117
- Watch G0117 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0117
Sources: CMS HCPCS Level II release October 2026; 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.