New CMS G Codes for ASCVD Risk Assessment and Management (2025)

 The Centers for Medicare and Medicaid Services (CMS) introduced two new G codes in the 2025 Medicare Physician Fee Schedule to reimburse for ASCVD risk assessment and management services.

The codes are inspired by the CMS Innovation Center’s Million Hearts® Cardiovascular Disease Risk Reduction model, which reduced all-cause death rates by 4% and cardiovascular event death rates by 11% for medium and high-risk patients.

The ASCVD risk assessment code, G0537, involves a standardized, evidence-based risk assessment for patients with ASCVD risk factors, lasting 5-15 minutes, and is billable once every 12 months.

This service applies to patients without a cardiovascular disease diagnosis or history of heart attack or stroke but with at least one predisposing condition like obesity, high blood pressure, or diabetes.

The risk assessment requires current laboratory data, a validated ASCVD risk assessment tool, demographic factors, modifiable risk factors, and possible risk enhancers to produce a documented 10-year ASCVD risk estimate.

Tools like the ACC ASCVD Risk Estimator meet these requirements, and the G0537 code is assigned a work RVU of 0.18.

The ASCVD risk management code, G0538, is for managing intermediate, medium, or high-risk patients identified through an ASCVD risk assessment.

The management service involves creating and implementing an ASCVD-specific care plan that incorporates shared decision-making and addresses risk factors like blood pressure, cholesterol, smoking, and nutrition.

These services include medication management, care coordination, non-face-to-face communication options, and individualized electronic care plans targeting modifiable risk factors.

The G0538 code, assigned a work RVU of 0.18, may apply monthly, but cost-sharing may be required since the service is not classified as preventive.

CMS emphasizes that patient consent is necessary for these services, which can be performed by physicians or qualified health professionals.

Further guidance and resources from CMS for using these codes will be shared by the ACC in the coming weeks.

Take-Home Points: 

• Two new codes (G0537 and G0538) reimburse ASCVD risk assessment and management.
• G0537: Annual risk assessment (5-15 minutes) for patients with predisposing conditions (e.g., obesity, hypertension). Requires a lipid panel and a validated tool like the ACC ASCVD Risk Estimator.
• G0538: Monthly risk management for patients identified as intermediate/high risk. Includes care plans addressing ABCS (Aspirin, Blood pressure, Cholesterol, Smoking cessation) and shared decision-making.
• Patient consent is required; cost-sharing applies to management services.
• Inspired by the Million Hearts® model, which reduced cardiovascular mortality by 11%.