G1011 HCPCS code: Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program
G1011 is the HCPCS Level II code for clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program. CMS terminated G1011 on 2024-12-31; do not bill it for later dates of service. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Z2 |
| Added | 2020-01-01 |
| Last action effective | 2025-01-01 |
| Terminated | 2024-12-31 |
What changed for G1011
- 2020-01-01: G1011 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 G1011?
G1011 is the HCPCS Level II code for clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program. Short descriptor: "Cdsm qualified nos".
Does Medicare cover G1011?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G10 codes
- G1000 — Clinical decision support mechanism applied pathways, as defined by the medicare appropriate use criteria program
- G1001 — Clinical decision support mechanism evicore, as defined by the medicare appropriate use criteria program
- G1002 — Clinical decision support mechanism medcurrent, as defined by the medicare appropriate use criteria program
- G1003 — Clinical decision support mechanism medicalis, as defined by the medicare appropriate use criteria program
- G1004 — Clinical decision support mechanism national decision support company, as defined by the medicare appropriate use criteria program
- G1005 — Clinical decision support mechanism national imaging associates, as defined by the medicare appropriate use criteria program
- G1006 — Clinical decision support mechanism test appropriate, as defined by the medicare appropriate use criteria program
- G1007 — Clinical decision support mechanism aim specialty health, as defined by the medicare appropriate use criteria program
- G1008 — Clinical decision support mechanism cranberry peak, as defined by the medicare appropriate use criteria program
- G1009 — Clinical decision support mechanism sage health management solutions, as defined by the medicare appropriate use criteria program
- G1010 — Clinical decision support mechanism stanson, as defined by the medicare appropriate use criteria program
- G1012 — Clinical decision support mechanism agilemd, as defined by the medicare appropriate use criteria program
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Next steps
- Run a reimbursement report for a device billed under G1011
- Watch G1011 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G1011
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.