G1028 HCPCS code: Take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure
G1028 is the HCPCS Level II code for take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure. In 2024 Medicare paid an average of $122.45 per service for G1028 across 649 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. Medicare volume rose 160% from 2023 to 2024 (250 to 649 services). In 2024, about 34 clinicians billed Medicare for G1028 for 225 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 | Z2 |
| Added | 2022-01-01 |
| Last action effective | 2022-01-01 |
Who bills G1028 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 34 |
| Medicare beneficiaries | 225 |
| States with claims | 4 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G1028, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 250 | 130 | $104.05 | $102.11 |
| 2024 | 649 | 225 | $123.04 | $122.45 |
States with the most G1028 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 581 | $122.16 |
| Oregon | 28 | $125.18 |
| Maryland | 21 | $124.16 |
| Michigan | 18 | $125.31 |
Medicare policy articles for this code
- A59718: Billing and Coding: Opioid Treatment Programs (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (39 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| F11.10 | Opioid abuse, uncomplicated | 1 |
| F11.11 | Opioid abuse, in remission | 1 |
| F11.120 | Opioid abuse with intoxication, uncomplicated | 1 |
| F11.121 | Opioid abuse with intoxication delirium | 1 |
| F11.122 | Opioid abuse with intoxication with perceptual disturbance | 1 |
| F11.13 | Opioid abuse with withdrawal | 1 |
| F11.14 | Opioid abuse with opioid-induced mood disorder | 1 |
| F11.150 | Opioid abuse with opioid-induced psychotic disorder with delusions | 1 |
| F11.151 | Opioid abuse with opioid-induced psychotic disorder with hallucinations | 1 |
| F11.181 | Opioid abuse with opioid-induced sexual dysfunction | 1 |
Showing 10 of 39. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for G1028
- 2022-01-01: G1028 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 G1028?
G1028 is the HCPCS Level II code for take-home supply of nasal naloxone; 2-pack of 8mg per 0.1 ml nasal spray (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure. Short descriptor: "Take home supply 8mg per 0.1".
How much does Medicare pay for G1028?
In 2024, the average Medicare payment was $122.45 per service (average allowed $123.04).
Does Medicare cover G1028?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for G1028?
Medicare policy articles that cite G1028 list 39 covered ICD-10-CM diagnosis codes across 1 article. The most cited include F11.10 (Opioid abuse, uncomplicated), F11.11 (Opioid abuse, in remission), F11.120 (Opioid abuse with intoxication, uncomplicated). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
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
- G1011 — Clinical decision support mechanism, qualified tool not otherwise specified, as defined by the medicare appropriate use criteria program
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 G1028
- Watch G1028 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G1028
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.