G2172 HCPCS code: All inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project
G2172 is the HCPCS Level II code for all inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project. In 2024 Medicare paid an average of $329.77 per service for G2172 across 1,276 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 36% from 2022 to 2024 (1,986 to 1,276 services). In 2024, about 97 clinicians billed Medicare for G2172 for 471 beneficiaries; Maryland, Tennessee, Delaware accounted for 72% of services.
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 | 2021-04-01 |
| Last action effective | 2021-04-01 |
Who bills G2172 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 97 |
| Medicare beneficiaries | 471 |
| States with claims | 9 |
| Share of services in top 3 states (Maryland, Tennessee, Delaware) | 72% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G2172, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,986 | 766 | $338.09 | $338.09 |
| 2023 | 2,049 | 795 | $327.19 | $327.19 |
| 2024 | 1,276 | 471 | $329.77 | $329.77 |
States with the most G2172 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Maryland | 385 | $330.75 |
| Tennessee | 275 | $330.75 |
| Delaware | 189 | $330.75 |
| Virginia | 134 | $330.75 |
| Oregon | 72 | $330.75 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Nature of Service/Procedure |
| practitioner claims | 1 | Nature of Service/Procedure |
What changed for G2172
- 2021-04-01: G2172 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 G2172?
G2172 is the HCPCS Level II code for all inclusive payment for services related to highly coordinated and integrated opioid use disorder (oud) treatment services furnished for the demonstration project. Short descriptor: "Tx for opioid use demo proj".
How much does Medicare pay for G2172?
In 2024, the average Medicare payment was $329.77 per service (average allowed $329.77).
Does Medicare cover G2172?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of G2172 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
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 G2172
- Watch G2172 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G2172
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.