G2169 HCPCS code: Services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes
G2169 is the HCPCS Level II code for services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes. 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 | Y1 |
| Added | 2020-01-01 |
| Last action effective | 2020-01-01 |
Medicare policy articles for this code
- A53057: Billing and Coding: Home Health Occupational Therapy (Palmetto GBA (HHH MAC))
- A53057: Billing and Coding: Home Health Occupational Therapy (Palmetto GBA (HHH MAC))
Covered diagnoses (7,834 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| A18.01 | Tuberculosis of spine | 1 |
| A18.02 | Tuberculous arthritis of other joints | 1 |
| A52.16 | Charcot's arthropathy (tabetic) | 1 |
| B91 | Sequelae of poliomyelitis | 1 |
| E08.40 | Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified | 1 |
| E08.42 | Diabetes mellitus due to underlying condition with diabetic polyneuropathy | 1 |
| E08.44 | Diabetes mellitus due to underlying condition with diabetic amyotrophy | 1 |
| E08.52 | Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene | 1 |
| E08.610 | Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy | 1 |
| E08.618 | Diabetes mellitus due to underlying condition with other diabetic arthropathy | 1 |
Showing 10 of 7,834. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for G2169
- 2020-01-01: G2169 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 G2169?
G2169 is the HCPCS Level II code for services performed by an occupational therapist assistant in the home health setting in the delivery of a safe and effective occupational therapy maintenance program, each 15 minutes. Short descriptor: "Svs by ot in home health".
Does Medicare cover G2169?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for G2169?
Medicare policy articles that cite G2169 list 7,834 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include A18.01 (Tuberculosis of spine), A18.02 (Tuberculous arthritis of other joints), A52.16 (Charcot's arthropathy (tabetic)). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Related G21 codes
- G2100 — Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
- G2101 — Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
- G2102 — Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed
- G2103 — Seven standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed
- G2104 — Eye imaging validated to match diagnosis from seven standard field stereoscopic photos results documented and reviewed
- G2105 — Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
- G2106 — Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
- G2107 — Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
- G2108 — Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period
- G2109 — Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period
- G2110 — Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ed or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period
- G2112 — Patient receiving <=5 mg daily prednisone (or equivalent), or ra activity is worsening, or glucocorticoid use is for less than 6 months
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 G2169
- Watch G2169 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G2169
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.