G0166 HCPCS code: External counterpulsation, per treatment session
G0166 is the HCPCS Level II code for external counterpulsation, per treatment session. In 2024 Medicare paid an average of $81.57 per service for G0166 across 41,985 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on outpatient hospital claims. Medicare volume fell 15% from 2022 to 2024 (49,673 to 41,985 services). In 2024, about 286 clinicians billed Medicare for G0166 for 1,538 beneficiaries; Texas, California, Florida accounted for 81% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 11 — Priced using national relative value units (Physician Fee Schedule) |
| BETOS category | P6C |
| Added | 2000-01-01 |
| Last action effective | 2000-01-01 |
Who bills G0166 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 286 |
| Medicare beneficiaries | 1,538 |
| States with claims | 14 |
| Share of services in top 3 states (Texas, California, Florida) | 81% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0166, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 49,673 | 1,890 | $113.83 | $90.14 |
| 2023 | 45,389 | 1,706 | $107.89 | $85.30 |
| 2024 | 41,985 | 1,538 | $103.50 | $81.57 |
States with the most G0166 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 14,627 | $77.18 |
| California | 12,657 | $92.35 |
| Florida | 5,314 | $76.50 |
| North Carolina | 1,801 | $73.90 |
| Nevada | 1,246 | $75.69 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Nature of Service/Procedure |
| practitioner claims | 2 | Nature of Service/Procedure |
What changed for G0166
- 2000-01-01: G0166 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 G0166?
G0166 is the HCPCS Level II code for external counterpulsation, per treatment session. Short descriptor: "Extrnl counterpulse, per tx".
How much does Medicare pay for G0166?
In 2024, the average Medicare payment was $81.57 per service (average allowed $103.50).
Does Medicare cover G0166?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of G0166 can be billed per day?
2 on outpatient hospital claims; 2 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
- 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
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 G0166
- Watch G0166 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0166
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.