HCPCS code G0238: Respiratory therapy, individual, other therapeutic procedures2026 Medicare rate & RVUs in Illinois
Reports individualized, face-to-face respiratory therapy to improve respiratory function through procedures other than respiratory-muscle strength or endurance training.
Medicare pays $10.59–$11.91 for G0238 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What G0238 covers
G0238 represents individualized respiratory therapy intended to improve respiratory function through therapeutic procedures outside the respiratory-muscle strength or endurance work assigned to G0237. A respiratory therapist or other clinical staff member typically provides the face-to-face treatment in an outpatient respiratory-care or pulmonary rehabilitation setting. The service is delivered to one patient at a time, and monitoring is included.
Report the service in 15-minute units, supported by documentation of the procedures performed and the face-to-face treatment time. The record should distinguish the work from respiratory-muscle strength or endurance training and from a group session. CMS treats G0238 as an incident-to service: it may be billed only when performed under physician supervision. Its fee schedule relative-value profile assigns no physician work RVUs; practice expense and malpractice RVUs are included.
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 G0238 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$10.59 to $11.91
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $11.84 | Unavailable |
| East St. Louis, IL | $10.81 | Unavailable |
| Rest of Illinois | $10.59 | Unavailable |
| Suburban Chicago, IL | $11.91 | Unavailable |
How the G0238 rate is calculated
Each of G0238’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.
How the rate is built · G0238
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.33
0.33 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.3400
Conversion factor
$33.4009
Medicare rate
$11.36
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for G0238
The CMS indicators that decide how G0238 is paid alongside other services.
CMS payment indicators · G0238
Respiratory therapy, individual, other therapeutic procedures
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
G0238 compared with similar codes
Compare codes · National
G0238 vs G0237 vs G0239: Medicare rates
How to choose
- G0237Respiratory therapyMuscle strength or endurance
- Choose G0237 when the individual treatment targets respiratory-muscle strength or endurance. G0238 covers other individualized procedures intended to improve respiratory function.
- G0239Respiratory therapyGroup, each 15 minutes
- G0238 is an individual service; G0239 describes respiratory procedures delivered in a group setting.
G0238 billing questions
When should G0238 be selected instead of G0237?
Use G0238 for individualized respiratory therapy aimed at improving respiratory function through procedures other than respiratory-muscle strength or endurance training. G0237 describes that strength or endurance focus.
How does G0238 differ from G0239?
G0238 is provided to one patient at a time. G0239 is for respiratory procedures delivered to a group.
How are units reported?
The service is reported in 15-minute units. Document the face-to-face treatment time and the procedures performed to support the units billed.
Does the service include monitoring?
Yes. Monitoring is included in the G0238 service; it is not a separate G0238 unit.
What supervision is required for billing?
CMS identifies G0238 as an incident-to service. It may be billed only when performed under physician supervision.
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
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