G0238 Oth resp proc, indivTherapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)
Status A: active, paid separately under the PFS if covered. National amounts: non-facility $11.36, facility $11.36 (total RVUs 0.34 / 0.34 × $33.4009 conversion factor; facility NA: rarely or never done in that setting). Work RVU 0.00, practice expense RVU 0.33 non-facility and 0.33 facility, malpractice RVU 0.01. Global period XXX. Qualifying APM participants are paid at a $33.5675 conversion factor.
4 of 6 payer prior-auth lists that name G0238 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Shield of California, Molina Healthcare of Ohio, Molina Healthcare of Texas.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Federal Employee Program (FEP) | AZ | prior auth under conditions | FEP Blue Focus only | Sep 1, 2026 | Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) |
| Blue Shield of California | Blue Shield commercial | CA | prior auth under conditions | CalPERS ASO only | Sep 1, 2026 | Prior Authorization List for Blue Shield |
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | *Allow first visit for cardiopulmonary rehab without PA. All additional visits will… | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Allow first visit for cardiopulmonary rehab without PA. All additional visits will… | Oct 1, 2022 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 |
G0238 appears in 11 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, BlueCross BlueShield of South Carolina.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Chest Physiotherapy and Airway Clearance Devices (0067) | covered if criteria are met | Mar 18, 2026 | payer document |
| Aetna | Obstructive Sleep Apnea in Adults (0004) | not covered | Oct 6, 2026 | payer document |
| Aetna | Obstructive Sleep Apnea in Children (0752) Montelukast, DNA (daytime and nighttime appliance) | not covered | Oct 30, 2025 | payer document |
| Aetna | Pulmonary Rehabilitation (0032) | covered if criteria are met | Mar 5, 2026 | payer document |
| Aetna | Urinary Incontinence (0223) | covered if criteria are met | Jul 16, 2026 | payer document |
| Anthem | Pulmonary Rehabilitation (CG-REHAB-03) | covered if criteria are met | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Outpatient Pulmonary Rehabilitation sad | covered if criteria are met | Apr 1, 2026 | payer document |
| Blue Cross Blue Shield of Massachusetts | Outpatient Pulmonary Rehabilitation (136) | listed, no stance | payer document | |
| Blue Shield of California | BSC8.08 | Occupational Therapy | listed, no stance | payer document | |
| Blue Shield of California | | Outpatient Pulmonary Rehabilitation (8.03.05) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Outpatient Pulmonary Rehabilitation (CAM 80305) 97799 | Unlisted physical medicine/rehabilitation service or procedure | listed, no stance (range G0237-G0239) | Jan 1, 2026 | payer document |
Prior authorization required or conditional in IN, WV.
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.