G0526 — Management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model
G0526 is a HCPCS Level II code for management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model. 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 statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
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 G0526
- Long descriptor
- Management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model
- Short descriptor
- Est pt-cg dyad dem hig cmplx
- Added
- July 1, 2024
- BETOS
- Z2
- Pricing indicator
- 13 — Physician fee schedule
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.
Price established by carriers — not otherwise classified, individual determination, or carrier discretion.
Codes adjacent to G0526
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G0526 is not quite right, the correct code is very often within a few positions of it.
- G0518Removal with reinsertion, non-biodegradable drug delivery implants, 4 or more (services for subdermal implants)
- G0519Management of new patient-caregiver dyad with dementia, low complexity, for use in cmmi model
- G0520Management of new patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model
- G0521Management of new patient-caregiver dyad with dementia, high complexity, for use in cmmi model
- G0522Management of a new patient with dementia, low complexity, for use in cmmi model
- G0523Management of a new patient with dementia, moderate to high complexity, for use in cmmi model
- G0524Management of established patient-caregiver dyad with dementia, low complexity, for use in cmmi model
- G0525Management of established patient-caregiver dyad with dementia, moderate complexity, for use in cmmi model
- G0527Management of established patient with dementia, low complexity, for use in cmmi model
- G0528Management of established patient with dementia, moderate to high complexity, for use in cmmi model
- G0529In-home respite care, 4-hour unit, for use in cmmi model
- G0530Adult day center, 8-hour unit, for use in cmmi model
- G0531Facility-based respite, 24-hour unit, for use in cmmi model
- G0532Take-home supply of nasal nalmefene hydrochloride; one carton of two, 2.7 mg per 0.1 ml nasal sprays (provision of the services by a medicare-enrolled opioid treatment program);( list separately in addition to each primary code)
- G0533Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a medicare-enrolled opioid treatment program)
- G0534Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction interventions and recovery support services a patient needs and wishes to pursue, which significantly limit the ability to diagnose or treat an opioid use disorder; each additional 30 minutes of services (provision of the services by a medicare-enrolled opioid treatment program); (list separately in addition to each primary code)
Questions about G0526
What is HCPCS code G0526?
G0526 is a HCPCS Level II code for management of established patient-caregiver dyad with dementia, high complexity, for use in cmmi model. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G0526?
The CMS HCPCS file marks G0526 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 G0526 paid under the physician fee schedule?
G0526 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.