$19.95
Choose G0537 for the ASCVD risk-assessment service. G0538 describes clinical staff management work provided on a monthly basis.
On this page
CMS RVU26D · Effective 2026-10-01
G0538 ASCVD management Medicare reimbursement rates in Wyoming
Monthly clinical staff services for managing a patient’s atherosclerotic cardiovascular disease risk, reported for the month in which that work is provided. Compare G0538 office and facility rates across CMS payment localities in Wyoming.
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 G0538 in Wyoming?
Wyoming 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
$16.95
1 of 1 localities have a supported rate.
Payment area: Wyoming**
One mapped payment locality.
Facility setting
$7.93
1 of 1 localities have a supported rate.
Payment area: Wyoming**
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.
Care management
About G0538: Monthly ASCVD risk management by clinical staff
Monthly clinical staff services for managing a patient’s atherosclerotic cardiovascular disease risk, reported for the month in which that work is provided.
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.
Where the value comes from
- Work RVU0.18 · 35%
- Practice expense (office) RVU0.32 · 63%
- 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.
G0538 compared with similar codes
Office rates for Wyoming, from the same CMS release.
$67.20
99426 is principal care management by clinical staff for a qualifying single high-risk condition. G0538 is specifically identified with ASCVD risk management.
$33.72
G0446 is annual face-to-face intensive behavioral counseling for cardiovascular disease. G0538 describes monthly clinical staff risk management.
Compare G0538 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
Wyoming** →
Office / nonfacility
$16.95
Facility
$7.93
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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 G0538 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
15,333
- Code
- G0538
- Physician work
- 0.18
- Practice expense
- 0.32
- Malpractice
- 0.01
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.18 | × 1.000 | 0.1800 |
| Practice expense | 0.32 | × 1.000 | 0.3200 |
| Malpractice | 0.01 | × 0.740 | 0.0074 |
| Total RVUs | 0.5074 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wyoming**$16.95
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.18 | 1 |
| Practice expense | 0.32 | 1 |
| Malpractice | 0.01 | 0.74 |
(0.18 × 1 + 0.32 × 1 + 0.01 × 0.74) × $33.4009 = $16.95
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.18 | 1 |
| Practice expense | 0.05 | 1 |
| Malpractice | 0.01 | 0.74 |
(0.18 × 1 + 0.05 × 1 + 0.01 × 0.74) × $33.4009 = $7.93
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.
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 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.
15,330G0535,,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
15,336G0541,,No pt prsnt train initial 30,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
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,