G0535 HCPCS Level II code: Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and…
G0535 is the HCPCS code for “Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient…” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
G0535Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; 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)
Short description: Pt navigat svs direct/ref
HCPCS · United States
Medicare details
The indicators CMS publishes with G0535 in its October 2026 file. They describe Medicare’s handling, not another payer’s.
- Medicare coverage
- Carrier judgment
- Medicare pricing
- Physician fee schedule – Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)
- Type of service
- Medical care
- BETOS category
- Specialist - other
- Added
- Jan 1, 2025
Where G0535 sits
- 1G codesProcedures and professional services
- 2Active code G0535Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; 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)
Source and release
- Data release
- HCPCS Level II · October 2026
- Effective date
- Oct 1, 2026
- Publisher
- CMS
This page is built from the HCPCS Level II catalog that Vero Codes reads when it suggests codes: Centers for Medicare & Medicaid Services’s October 2026 release, imported from the publisher’s file and checked against it. The description, notes and structured data come from the same record.
Frequently asked questions
What does HCPCS code G0535 mean?
G0535 is the HCPCS code for “Patient navigational services, provided directly or by referral; including helping the patient to navigate health systems and identify care providers and supportive services, to build patient self-advocacy and communication skills with care providers, and to promote patient-driven action plans and goals; 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)” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover G0535?
CMS lists G0535’s Medicare coverage as “Carrier judgment” and its pricing as “Physician fee schedule – Price established by carriers (e.g., not otherwise classified, individual determination, carrier discretion)”. Coverage and payment still depend on the patient, the setting, the documentation and the payer.
Which HCPCS Level II release does this page use?
It uses CMS’s October 2026 release, in effect from Oct 1, 2026 to Dec 31, 2026. It is a reference: confirm the code against the current list and the payer’s rules before you submit it.
Codes beside G0535
All G codesG0529In-home respite care, 4-hour unit, for use in cmmi modelG0530Adult day center, 8-hour unit, for use in cmmi modelG0531Facility-based respite, 24-hour unit, for use in cmmi modelG0532Take-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)…G0533Medication assisted treatment, buprenorphine (injectable) administered on a weekly basis; weekly bundle including dispensing and/or administration, substance use counseling…G0534Coordinated care and/or referral services, such as to adequate and accessible community resources to address unmet health-related social needs, including harm reduction…G0536Peer recovery support services, provided directly or by referral; including leveraging knowledge of the condition or lived experience to provide support, mentorship, or…G0537Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ascvd) risk assessment, 5-15 minutes, not more often than every 12 monthsG0538Atherosclerotic cardiovascular disease (ascvd) risk management services; clinical staff time; per calendar monthG0539Caregiver training in behavior management/modification for caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified…G0540Caregiver training in behavior management/modification for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or…G0541Caregiver training in direct care strategies and techniques to support care for patients with an ongoing condition or illness and to reduce complications (including, but not…