G0397 HCPCS code: Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes
G0397 is the HCPCS Level II code for alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes. In 2024 Medicare paid an average of $50.04 per service for G0397 across 2,352 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 23% from 2022 to 2024 (3,057 to 2,352 services). In 2024, about 154 clinicians billed Medicare for G0397 for 1,148 beneficiaries; New York, California, New Jersey accounted for 62% 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 | M5D |
| Added | 2008-01-01 |
| Last action effective | 2020-10-01 |
Who bills G0397 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 154 |
| Medicare beneficiaries | 1,148 |
| States with claims | 13 |
| Share of services in top 3 states (New York, California, New Jersey) | 62% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0397, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,057 | 1,408 | $61.31 | $45.99 |
| 2023 | 2,422 | 1,388 | $62.14 | $46.13 |
| 2024 | 2,352 | 1,148 | $65.81 | $50.04 |
States with the most G0397 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 638 | $56.42 |
| California | 397 | $52.23 |
| New Jersey | 298 | $45.89 |
| New Hampshire | 278 | $52.23 |
| Texas | 120 | $48.70 |
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 |
What changed for G0397
- 2008-01-01: G0397 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 G0397?
G0397 is the HCPCS Level II code for alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes. Short descriptor: "Alcohol/subs interv >30 min".
How much does Medicare pay for G0397?
In 2024, the average Medicare payment was $50.04 per service (average allowed $65.81).
Does Medicare cover G0397?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of G0397 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related G03 codes
- G0300 — Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutes
- G0302 — Pre-operative pulmonary surgery services for preparation for lvrs, complete course of services, to include a minimum of 16 days of services
- G0303 — Pre-operative pulmonary surgery services for preparation for lvrs, 10 to 15 days of services
- G0304 — Pre-operative pulmonary surgery services for preparation for lvrs, 1 to 9 days of services
- G0305 — Post-discharge pulmonary surgery services after lvrs, minimum of 6 days of services
- G0306 — Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count
- G0307 — Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)
- G0308 — Creation of subcutaneous pocket with insertion of 180 day implantable interstitial glucose sensor, including system activation and patient training
- G0309 — Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 180 day implantable sensor, including system activation
- G0310 — Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 5 to 15 mins time (this code is used for medicaid billing purposes)
- G0311 — Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service, 16-30 mins time (this code is used for medicaid billing purposes)
- G0312 — Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service for ages under 21, 5 to 15 mins time (this code is used for medicaid billing purposes)
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Next steps
- Run a reimbursement report for a device billed under G0397
- Watch G0397 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G0397
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.