HCPCS code G0160: Home health OT, maintenance, per 15 minutes2026 Medicare rate & RVUs

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What G0160 covers

G0160 identifies occupational therapy provided by a qualified occupational therapist in the home health setting to establish or deliver a safe and effective maintenance program. An occupational therapist provides the service in the patient’s home as part of home health care. The code identifies establishment or delivery of the maintenance program, distinguishing this service from home health OT services generally and OT assistant services.

Each unit represents 15 minutes of the described service. CMS assigns G0160 physician fee schedule status E, excluding it from the physician fee schedule by regulation, and the HCPCS pricing designation says it is not separately priced by Medicare Part B. When Medicare covers the service, payment is under another payment method. Coverage is left to the Medicare contractor’s judgment.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where G0160 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

G0160 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the G0160 rate is calculated

Each of G0160’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for G0160

G0160 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

G0160 compared with similar codes

How to choose

G0152Occupational therapyHome health or hospice, per 15 minutes

G0152 identifies home health occupational therapy services generally. G0160 is specific to establishing or delivering a safe, effective occupational therapy maintenance program.

G0158OT assistantPer 15 minutes

G0158 identifies home health occupational therapy assistant services. G0160 describes maintenance-program services performed by a qualified occupational therapist.

G0159PT maintenancePer 15 minutes

G0159 identifies home health physical therapy maintenance services. G0160 applies to occupational therapy maintenance services.

Codes related to G0160

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates