HCPCS G0138: IV enzyme drugMedicare rate & RVUs in Florida
Reports the amount of intravenous cipaglucosidase alfa-atga administered as enzyme replacement therapy for adults with late-onset Pompe disease.
Medicare pays $188.98–$206.65 for G0138 in the office in Florida, from Rest Of Florida to Miami. 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.
On this page 9 sections
What G0138 covers
G0138 identifies cipaglucosidase alfa-atga, an intravenous enzyme replacement drug used with oral miglustat to treat adults with late-onset Pompe disease. It is typically administered by infusion staff in an outpatient infusion center or hospital outpatient department under a clinician’s treatment plan. The code represents the drug, not the work of administering the infusion.
Select G0138 when the administered product is cipaglucosidase alfa-atga, rather than another Pompe enzyme product. Report units based on the total milligrams administered using the code’s 10-mg unit. Documentation should identify the drug, dose, route, and administration date, with the patient’s weight and prescribed regimen supporting the dose. Report infusion administration separately when supported by the service performed; the drug units and administration service represent distinct claim elements.
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 G0138 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$188.98 to $206.65
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $200.19 | Unavailable |
| Miami | $206.65 | Unavailable |
| Rest Of Florida | $188.98 | Unavailable |
How the G0138 rate is calculated
Each of G0138’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 · G0138
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.21Practice expense 5.62Malpractice 0.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G0138
G0138 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 · G0138
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$196.40
Only one setting is priced for this code.
G0138 compared with similar codes
Compare codes
G0138 vs J0221 vs 96365 vs 96366: national Medicare rates
Swap in your local Medicare rate.
How to choose
- J0221Lumizyme injection
- J0221 identifies alglucosidase alfa, not cipaglucosidase alfa-atga. Choose based on the enzyme product actually administered.
- 96365IV drug infusion
- 96365 reports infusion administration, while G0138 reports the cipaglucosidase alfa-atga drug quantity.
- 96366IV infusion add-on hour
- 96366 reports additional-hour infusion administration; it does not identify or count the drug supplied.
G0138 billing questions
How many units should be reported?
G0138 represents 10 mg per unit. Calculate the claim units from the total milligrams administered and document the dose.
Is G0138 the infusion administration code?
No. It reports the drug quantity. Infusion administration may be reported separately when supported by the documented service, using the applicable administration code.
Can G0138 be used for alglucosidase alfa?
No. G0138 is specific to cipaglucosidase alfa-atga. Alglucosidase alfa is a different Pompe enzyme product reported with its own drug code.
What documentation supports the reported units?
Record the product administered and total milligrams given. The treatment plan and patient weight should support the prescribed dose.
Is miglustat included in G0138?
No. G0138 reports cipaglucosidase alfa-atga only; the combination treatment also includes oral miglustat.
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
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