$16.90
G0537 is the periodic ASCVD risk assessment; G0538 describes monthly ASCVD risk management by clinical staff.
On this page
CMS RVU26D · Effective 2026-10-01
G0537 ASCVD risk test Medicare reimbursement rates in Delaware
Reports a clinician’s assessment of a patient’s atherosclerotic cardiovascular disease risk, limited by the code descriptor to once per 12 months. Compare G0537 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for G0537 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$19.87
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$7.99
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Cardiovascular risk assessment
About G0537: ASCVD risk assessment
Reports a clinician’s assessment of a patient’s atherosclerotic cardiovascular disease risk, limited by the code descriptor to once per 12 months.
G0537 represents assessment of a patient’s risk for atherosclerotic cardiovascular disease (ASCVD). A clinician uses the patient’s cardiovascular risk information, such as age, blood pressure, cholesterol, smoking status, and diabetes history, to determine an overall risk estimate. The assessment may inform prevention discussions in primary care or another outpatient setting; it is not a laboratory test that measures risk by itself.
Report G0537 for the ASCVD risk assessment rather than for an isolated lipid result or a general preventive visit. Documentation should identify the risk assessment performed, relevant patient information considered, and the resulting risk estimate or interpretation. The descriptor specifies once per 12 months. G0538 describes a related monthly clinical-staff risk-management service, not another risk assessment. The CMS facts supplied for G0537 list no special payment rules, so this entry does not assign a component, global-period, or reduction rule.
Where the value comes from
- Work RVU0.18 · 30%
- Practice expense (office) RVU0.41 · 68%
- Malpractice RVU0.01 · 2%
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.
G0537 compared with similar codes
Office rates for Delaware, from the same CMS release.
80061
No office rateLipid panel
G0537 reports an assessment of cardiovascular risk. 80061 reports a lipid panel, which may provide data for that assessment.
$136.66
G0439 is a subsequent annual wellness visit. G0537 represents the distinct ASCVD risk assessment, not the overall wellness encounter.
Compare G0537 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
$19.87
Facility
$7.99
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for G0537 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
15,332
- Code
- G0537
- Physician work
- 0.18
- Practice expense
- 0.41
- Malpractice
- 0.01
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.18 | × 1.005 | 0.1809 |
| Practice expense | 0.41 | × 0.988 | 0.4051 |
| Malpractice | 0.01 | × 0.899 | 0.0090 |
| Total RVUs | 0.5950 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$19.87
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.18 | 1.005 |
| Practice expense | 0.41 | 0.988 |
| Malpractice | 0.01 | 0.899 |
(0.18 × 1.005 + 0.41 × 0.988 + 0.01 × 0.899) × $33.4009 = $19.87
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.18 | 1.005 |
| Practice expense | 0.05 | 0.988 |
| Malpractice | 0.01 | 0.899 |
(0.18 × 1.005 + 0.05 × 0.988 + 0.01 × 0.899) × $33.4009 = $7.99
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
G0537 billing questions
Is G0537 a lipid panel?
No. G0537 reports an ASCVD risk assessment; a lipid panel measures blood lipids and may provide information used in assessing risk.
How often can G0537 be reported?
The descriptor specifies once per 12 months. Document the assessment and the patient information used to support it.
How does G0537 differ from G0538?
G0537 is the risk assessment. G0538 describes ASCVD risk management performed by clinical staff on a monthly basis.
What documentation supports G0537?
Record the risk assessment performed, relevant risk-factor information reviewed, and the resulting estimate or clinical interpretation.
Can G0537 be reported with an annual wellness visit?
It may be reported when the ASCVD risk assessment is performed in addition to the wellness visit. Document the assessment as a distinct service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
15,329G0534,,Coordinated care/or referral,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,330G0535,,Pt navigat svs direct/ref,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,331G0536,,Peer recover support svs,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,332G0537,,Risk ascvd tst once pr 12 mo,A,,0.18,0.41,,0.05,,0.01,0.60,0.24,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,333G0538,,Ascvd rsk mng clin stf pr mo,A,,0.18,0.32,,0.05,,0.01,0.51,0.24,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,334G0539,,Initial care training 30 m,A,,1.00,0.58,,0.18,,0.01,1.59,1.19,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,335G0540,,Train for caregiver add 15,A,,0.54,0.24,,0.09,,0.00,0.78,0.63,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503