Billing Code Overview

HCPCS Level II code G0237 describes therapeutic procedures to increase strength or endurance of respiratory muscles, delivered face-to-face in a one-on-one setting. The code is reported in 15-minute increments and includes monitoring as part of the service.

Service type: Respiratory therapy / pulmonary rehabilitation individual component

Typical site of service: Outpatient setting under a physician plan of care, commonly billed on the CMS 1500 form with Place of Service 11 (Office).

Clinical Context

A patient with respiratory muscle weakness following a prolonged hospitalization for pulmonary mycobacterial infection presents to an outpatient physician’s office for pulmonary rehabilitation. The physician’s plan of care orders individual therapeutic respiratory muscle training to increase inspiratory and expiratory strength and endurance. A respiratory therapist provides one-on-one, face-to-face sessions of device-guided inspiratory muscle training and coached breathing exercises, with continuous monitoring of vital signs and technique. Each 15-minute block of monitored therapy is documented with start and stop times, therapeutic activities performed, patient response, and any adverse events. Services are delivered in an outpatient clinic (Place of Service 11) and billed on a CMS 1500 claim under a physician plan of care.

Coding Specifications

• HCPCS Level II code: G0237 — Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring).

• Common modifiers and when to use them:

• 59 — Distinct Procedural Service

• Use when two procedures that are not normally reported together are performed on the same day and meet documentation criteria demonstrating a distinct service or separate session from another procedure. Documentation must justify the distinct nature of the service.

• 76 — Repeat Procedure by Same Physician

• Use when the same service is repeated by the same provider during the same day and the payer requires a modifier to indicate the repetition. Documentation should show separate sessions and medical necessity for the repeat.

• Associated provider taxonomies and specialties:

• 227900000X — Respiratory Therapist, Certified

• Represents credentialed respiratory therapists who deliver hands-on respiratory therapeutic interventions and monitoring.

• 2278C0205X — Pulmonary Rehabilitation Respiratory Therapist

• Represents respiratory therapists with a focus in pulmonary rehabilitation programs and individual therapeutic training.

• 207RP1001X — Pulmonary Disease Physician

• Represents physicians specializing in pulmonary disease who establish the plan of care and orders for respiratory therapeutic procedures.

Related Diagnoses

• A15.0 — Tuberculosis of lung

• Relevant because pulmonary tuberculosis can cause chronic lung impairment and respiratory muscle deconditioning requiring targeted respiratory muscle training.

• A15.5 — Tuberculosis of larynx, trachea and bronchus

• Relevant when upper airway tuberculosis contributes to impaired airway function and respiratory mechanics addressed by therapeutic respiratory interventions.

• A15.6 — Tuberculous pleurisy

• Relevant when pleural involvement leads to restricted lung expansion and reduced respiratory muscle endurance, warranting rehabilitative therapy.

• A15.7 — Primary respiratory tuberculosis

• Relevant for initial respiratory tuberculosis disease that may cause respiratory muscle weakness or functional deficits addressed by therapy.

• A15.8 — Other respiratory tuberculosis

• Relevant for other specified respiratory tuberculosis conditions that can impair respiratory function and benefit from muscle-strengthening procedures.

• A20.2 — Pneumonic plague

• Relevant when severe pneumonic infection causes respiratory compromise and deconditioning that may require rehabilitative respiratory muscle training.

• A20.7 — Septicemic plague

• Relevant if systemic infection results in respiratory muscle weakness or prolonged ventilation exposure leading to need for strengthening interventions.

• A22.1 — Pulmonary anthrax

• Relevant when inhalational anthrax causes severe pulmonary injury and subsequent respiratory rehabilitation needs including muscle endurance training.

• A31.0 — Pulmonary mycobacterial infection

• Relevant for non-tuberculous mycobacterial pulmonary disease that can lead to chronic respiratory impairment requiring targeted therapy.

• A36.2 — Laryngeal diphtheria

• Relevant when laryngeal involvement affects airway patency and respiratory mechanics, potentially necessitating therapeutic respiratory interventions.

Related Codes

• G0238 is used for one-on-one therapeutic respiratory procedures that do not specifically fit the strength/endurance description in G0237; it may be reported when the intervention targets other aspects of respiratory function and is documented accordingly. G0238 can be an alternative when the documented interventions differ from those specified for G0237.

• G0239 is used when therapeutic procedures are delivered to two or more individuals simultaneously (group sessions) and therefore is an alternative to G0237 when the service is provided in a group rather than one-on-one. G0239 may be billed instead of G0237 when the clinical workflow involves group pulmonary rehabilitation sessions.

• G0238 and G0239 are commonly considered alternatives to G0237 depending on the documented intervention focus (strength/endurance vs. other respiratory function improvement) and the delivery format (individual one-on-one vs. group).

National mean rates for HCPCS Level II code G0237 place Medicare ($13.31) below the BUCA average commercial mean ($14.34). Blue Cross Blue Shield has the highest national mean at $17.83, while Aetna reports the lowest mean at $8.42.

Rate dispersion (P75 minus P25) varies across payers: UnitedHealthcare shows the widest spread (20.00 - 10.50 = $9.50), Blue Cross Blue Shield also shows a wide spread ($6.50), BUCA and Aetna show moderate spreads ($6.50 and $4.50 respectively), Medicare is among the tightest ($2.00), and Cigna Health is the tightest with no dispersion (P75 - P25 = $0.00). The table and chart below present the full breakdown.