`G0118` Glaucoma scrn hgh risk direc

Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction
Outpatient hospital: max 1 units per day (policy), rationale: Code Descriptor / CPT Instruction

Medicare pricing for G0118

Physician Fee Schedule (CY 2026, RVU26D)

Status T: injection, paid only when no other PFS service is billed that day. National amounts: non-facility $40.42, facility $40.42 (total RVUs 1.21 / 1.21 × $33.4009 conversion factor; facility NA: rarely or never done in that setting). Work RVU 0.17, practice expense RVU 1.03 non-facility and 1.03 facility, malpractice RVU 0.01. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.

Payer policies and prior authorization for G0118

Payer coverage policies that name G0118

G0118 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Corneal Pachymetry (0681)	listed, no stance	Oct 15, 2025	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

AZ: $24.53 (outpatient_hospital), effective Oct 1, 2021
CO: $21.44 (chp_plus, non-facility), effective Jul 1, 2026
LA: $32.01 (professional), effective Jul 1, 2025
MT: $0.00 (optometric, facility), effective Jul 1, 2019
ND: $0.00 (physician), effective Aug 1, 2026
VT: $29.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $25.23 (physician, facility), effective Jul 1, 2026
WY: $16.52 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

G0118 Glaucoma scrn hgh risk direc