HCPCS G0538: ASCVD managementMedicare rate & RVUs
Monthly clinical staff services for managing a patient’s atherosclerotic cardiovascular disease risk, reported for the month in which that work is provided.
Medicare pays $17.03 for G0538 nationally in the office and $8.02 in a hospital or facility. Local office rates run $15.37–$22.27.
Medicare rate · G0538
ASCVD management
Swap in your local Medicare rate.
- Work RVUs
- 0.18
- Total RVUs
- 0.51
- Global days
- XXX
National rate · 2026
$17.03
Office setting, before claim adjustments.
See every locality for G0538 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 sections
What G0538 covers
G0538 represents monthly ASCVD risk-management work performed by clinical staff, rather than the risk calculation itself. The service is relevant when a practice is addressing a patient’s cardiovascular risk through ongoing clinical support, such as follow-through on risk-reduction planning and communication with the care team. It is distinct from a one-time ASCVD risk assessment and is not a code for a particular test or procedure.
Report the code for the month in which the staff management service occurs. The record should identify the patient’s ASCVD-related risk-management needs and document the staff work performed during the month, including relevant follow-up or care coordination. Keep this monthly service separate in the record from an ASCVD risk assessment or other counseling and care-management services performed for the patient. The CMS rules supplied for this code list no special payment provisions.
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 G0538 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$15.37 to $22.27
109 of 109 payment localities
G0538 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$15.37
$20.59
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $20.59 | 1 |
| AL | $15.55 | 1 |
| AR | $15.37 | 1 |
| AZ | $16.66 | 1 |
| CA | $18.01–$22.27 | 29 |
| CO | $17.72 | 1 |
| CT | $18.05 | 1 |
| DC | $19.30 | 1 |
| DE | $16.90 | 1 |
| FL | $16.73–$17.98 | 3 |
| GA | $15.94–$17.29 | 2 |
| GU | $18.36 | 1 |
| HI | $18.36 | 1 |
| IA | $15.92 | 1 |
| ID | $16.00 | 1 |
| IL | $16.29–$17.62 | 4 |
| IN | $16.08 | 1 |
| KS | $15.84 | 1 |
| KY | $15.82 | 1 |
| LA | $15.79–$16.45 | 2 |
| MA | $17.63–$19.32 | 2 |
| MD | $17.20–$19.30 | 3 |
| ME | $16.05–$16.82 | 2 |
| MI | $16.15–$16.89 | 2 |
| MN | $17.11 | 1 |
| MO | $15.55–$16.52 | 3 |
| MS | $15.46 | 1 |
| MT | $17.03 | 1 |
| NC | $16.20 | 1 |
| ND | $16.84 | 1 |
| NE | $16.00 | 1 |
| NH | $17.43 | 1 |
| NJ | $18.29–$19.15 | 2 |
| NM | $16.21 | 1 |
| NV | $16.99 | 1 |
| NY | $16.40–$19.73 | 5 |
| OH | $16.11 | 1 |
| OK | $15.82 | 1 |
| OR | $16.89–$18.23 | 2 |
| PA | $16.14–$17.65 | 2 |
| PR | $17.15 | 1 |
| RI | $17.47 | 1 |
| SC | $16.17 | 1 |
| SD | $16.81 | 1 |
| TN | $15.91 | 1 |
| TX | $16.05–$17.63 | 8 |
| UT | $16.36 | 1 |
| VA | $16.75–$19.30 | 2 |
| VI | $17.15 | 1 |
| VT | $16.76 | 1 |
| WA | $17.60–$19.70 | 2 |
| WI | $16.35 | 1 |
| WV | $15.78 | 1 |
| WY | $16.95 | 1 |
How the G0538 rate is calculated
Each of G0538’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 · G0538
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.18Practice expense 0.32Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G0538
G0538 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.
Place of service · G0538
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$17.03
The facility rate would be $8.02 (+$9.01). In a facility, the facility bills its own costs separately.
G0538 compared with similar codes
Compare codes
G0538 vs G0537 vs 99426 vs G0446: national Medicare rates
Swap in your local Medicare rate.
How to choose
- G0537ASCVD risk test
- Choose G0537 for the ASCVD risk-assessment service. G0538 describes clinical staff management work provided on a monthly basis.
- 99426Principal care management
- 99426 is principal care management by clinical staff for a qualifying single high-risk condition. G0538 is specifically identified with ASCVD risk management.
- G0446Cardiovascular counseling
- G0446 is annual face-to-face intensive behavioral counseling for cardiovascular disease. G0538 describes monthly clinical staff risk management.
G0538 billing questions
How is G0538 different from G0537?
G0538 describes monthly ASCVD risk-management services by clinical staff. G0537 is the ASCVD risk-assessment service, described as occurring once per 12 months.
Is G0538 reported for each staff contact?
The code is defined per month, not per contact. Document the management work provided during the month rather than treating each call or touchpoint as a separate monthly unit.
What documentation supports G0538?
Record the patient’s ASCVD risk-management needs and the clinical staff activities performed during the month, including relevant follow-up and care-team communication.
Can an ASCVD risk assessment and monthly management both be documented?
Yes, they describe different work: G0537 is risk assessment, while G0538 is monthly management. Document each service distinctly when both are provided.
Does G0538 describe a cardiovascular test?
No. It describes clinical staff management services; G0537 is the related code for ASCVD risk assessment.
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
Show the CMS file lines behind this rate
Fee sheets
Put G0538 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →