HCPCS G0516: Drug implant insertionMedicare rate & RVUs in Utah
Reports insertion of four or more drug-delivery implants, such as buprenorphine implant rods, during a single implantation procedure.
Medicare pays $167.86 for G0516 in the office in Utah (Utah). 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 G0516 covers
G0516 describes placing four or more drug-delivery implants beneath the skin. A familiar example is insertion of buprenorphine implant rods in the upper arm for maintenance treatment of opioid use disorder. The procedure is performed by a qualified clinician in an office or other appropriate setting; the site and number of implants distinguish it from insertion of a single implant or management of implants already in place.
Report G0516 for the insertion procedure when four or more implants are placed. The record should identify the medication or implant, the body site, the number inserted, and the clinical purpose. This is a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
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.
G0516 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $167.86 | $83.08 |
How the G0516 rate is calculated
Each of G0516’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 · G0516
RVUs × geographic indexes × conversion factor
Work1.77
1.77 RVUs× 1.000 GPCI
Practice expense3.32
3.32 RVUs× 1.000 GPCI
Malpractice0.15
0.15 RVUs× 1.000 GPCI
Adjusted RVUs
5.2400
Conversion factor
$33.4009
Medicare rate
$175.02
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for G0516
The CMS indicators that decide how G0516 is paid alongside other services.
CMS payment indicators · G0516
Drug implant insertion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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 | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
G0516 without 51 · national office
$175.02
Drug implant insertion
G0516-51 · Second procedure: 50%
$87.51
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
G0516 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- G0517Implant removal
- G0517 describes removing a drug-delivery implant. Use G0516 for insertion of four or more implants, not removal alone.
- G0518Implant replacement
- G0518 describes removing an implant and inserting a replacement. G0516 describes insertion of four or more implants without that removal-and-replacement service.
- 11981Drug implant insertion
- billing code 11981 describes insertion of a non-biodegradable drug-delivery implant. Choose the code that matches the applicable service and implant-count criteria; G0516 specifies four or more implants.
G0516 billing questions
When should G0516 be selected instead of a code for one implant?
Use G0516 when four or more drug-delivery implants are inserted in the procedure. A single-implant insertion is a different service and should not be reported as G0516.
Does G0516 include removal of existing implants?
G0516 represents insertion. G0517 describes removal, while G0518 describes removal with insertion of a replacement implant.
What documentation supports reporting G0516?
Document the implant or medication, insertion site, number of implants placed, and clinical purpose. The record should make clear that four or more implants were inserted.
Can modifier 50 be used for implants placed on both sides?
No. The CMS bilateral adjustment does not apply to G0516, and modifier 50 is inappropriate for this descriptor.
Can an assistant-at-surgery be reported with G0516?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
Is same-day postoperative care separately included in the global period?
No. G0516 has a 0-day global period, and same-day preoperative and postoperative care is included in the procedure.
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 G0516 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 →