`G0379` Direct refer hospital observ

Direct admission of patient for hospital observation care

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 1 units per day (policy), rationale: CMS Policy

Medicare pricing for G0379

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for G0379

2 of 2 payer prior-auth lists that name G0379 require prior authorization or set conditions: Humana.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Humana	Humana Healthy Horizons	LA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate
Humana	Oak Street Health	All	prior auth required			Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management

Payer coverage policies that name G0379

G0379 appears in 3 coverage policies from Blue Cross & Blue Shield of Rhode Island, Blue Cross NC.

Payer	Policy	Role in policy	Reviewed	Document
Blue Cross & Blue Shield of Rhode Island	DRAFT 2022 Outpatient Observation Services	listed, no stance	Jul 10, 2010	payer document
Blue Cross & Blue Shield of Rhode Island	Outpatient Observation Services	listed, no stance	Jul 10, 2010	payer document
Blue Cross NC	Observation, Facility	listed, no stance	Jan 1, 2025	payer document

Recent prior-auth changes

Aug 1, 2026: PA removed, HealthSpring

Medicaid fee-for-service

Prior authorization required or conditional in IN.

AZ: $30.00 (outpatient_hospital), effective Oct 1, 2015
ND: $0.00 (physician), effective Aug 1, 2026
VT: $462.41 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $263.37 (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.

G0379 Direct refer hospital observ