G0043 — Patients with mechanical prosthetic heart valve
G0043 is a HCPCS Level II code for patients with mechanical prosthetic heart valve. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusM
Measurement code. Used for reporting purposes only; never paid.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for G0043
- Long descriptor
- Patients with mechanical prosthetic heart valve
- Short descriptor
- Pt mech pros ht valv
- Added
- January 1, 2022
- BETOS
- Z2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to G0043
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G0043 is not quite right, the correct code is very often within a few positions of it.
- G0035Patient has any emergency department encounter during the performance period with place of service indicator 23
- G0036Patient or care partner decline assessment
- G0037On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available
- G0038Clinician determines patient does not require referral
- G0039Patient not referred, reason not otherwise specified
- G0040Patient already receiving physical/occupational/speech/recreational therapy during the measurement period
- G0041Patient and/or care partner decline referral
- G0042Referral to physical, occupational, speech, or recreational therapy
- G0044Patients with moderate or severe mitral stenosis
- G0045Clinical follow-up and mrs score assessed at 90 days following endovascular stroke intervention
- G0046Clinical follow-up and mrs score not assessed at 90 days following endovascular stroke intervention
- G0047Pediatric patient with minor blunt head trauma and pecarn prediction criteria are not assessed
- G0048Patients who receive palliative care services any time during the intake period through the end of the measurement year
- G0049With maintenance hemodialysis (in-center and home hd) for the complete reporting month
- G0050Patients with a catheter that have limited life expectancy
- G0051Patients under hospice care in the current reporting month
Questions about G0043
What is HCPCS code G0043?
G0043 is a HCPCS Level II code for patients with mechanical prosthetic heart valve. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G0043?
The CMS HCPCS file marks G0043 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G0043 paid under the physician fee schedule?
G0043 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.