J0221
No office rateLumizyme injection
J0221 identifies alglucosidase alfa, not cipaglucosidase alfa-atga. Choose based on the enzyme product actually administered.
On this page
CMS RVU26D · Effective 2026-10-01
G0138 IV enzyme drug Medicare reimbursement rates in Pennsylvania
Reports the amount of intravenous cipaglucosidase alfa-atga administered as enzyme replacement therapy for adults with late-onset Pompe disease. Compare G0138 office and facility rates across CMS payment localities in Pennsylvania.
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 G0138 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$180.91–$204.54
2 of 2 localities have a supported rate.
Facility setting
No supported rate
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.
Drug / biological
About G0138: Cipaglucosidase alfa-atga, per 10 mg
Reports the amount of intravenous cipaglucosidase alfa-atga administered as enzyme replacement therapy for adults with late-onset Pompe disease.
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.
Where the value comes from
- Work RVU0.21 · 4%
- Practice expense (office) RVU5.62 · 96%
- Malpractice RVU0.05 · 1%
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.
G0138 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$62.24–$69.93
96365 reports infusion administration, while G0138 reports the cipaglucosidase alfa-atga drug quantity.
$20.13–$22.17
96366 reports additional-hour infusion administration; it does not identify or count the drug supplied.
Compare G0138 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.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$204.54
Facility
Unavailable
Rest Of Pennsylvania →
Office / nonfacility
$180.91
Facility
Unavailable
Need rates for a whole code list?
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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 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.
15,102G0130,TC,Single energy x-ray study,A,,0.00,0.85,,0.85,NA,0.01,0.86,0.86,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,01,0,99,3.16,3.16,0.04
15,103G0136,,Adm of pa/n assess 5-15 m,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
15,104G0137,,"Inten outpt svs,min 9 pr 7 d",X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,105G0138,,Iv cipaglucosidase alfa-atga,A,,0.21,5.62,,5.62,NA,0.05,5.88,5.88,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,106G0140,,Nav srv peer sup 60 min pr m,A,,1.00,1.60,,0.26,,0.07,2.67,1.33,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,107G0141,,"Scr c/v cyto,autosys and md",A,,0.25,0.46,,0.46,,0.01,0.72,0.72,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,108G0143,,"Scr c/v cyto,thinlayer,rescr",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