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2025 HCPCS code G0058

Improving Care for Lower Extremity Joint Repair MIPS Value Pathways (MVP).

This code is reported once per performance period by providers participating in the Improving Care for Lower Extremity Joint Repair MVP.Refer to the current year's MIPS Value Pathways program guidelines for reporting requirements.

Medical necessity for procedures related to this MVP should be supported by documentation of the patient's condition and the clinical rationale for the chosen treatment. This may include imaging studies, functional assessments, and documentation of failed conservative treatments.Adherence to the MVP's quality measures aims to further ensure medical necessity and cost-effectiveness of care.

This code is specific to providers participating in the Improving Care for Lower Extremity Joint Repair Merit-based Incentive Payment System (MIPS) Value Pathways (MVP) program from Medicare. Participation in the MVP requires adherence to specific quality measures and activities related to the care of patients with osteoarthritis and those undergoing lower extremity joint repair, including fractures and joint replacements.

In simple words: This code indicates that your doctor is participating in a program to improve the quality of care for patients undergoing lower extremity joint repair, like knee and hip replacements. The program aims to ensure patients receive appropriate care and helps to lower healthcare costs.

This code is used to report participation in the Improving Care for Lower Extremity Joint Repair MIPS Value Pathways (MVP) program.This program focuses on providing fundamental treatment and management of patients with osteoarthritis and lower extremity surgical repair, such as fracture and total joint replacement, to ensure appropriate care and reduce costs.

Example 1: A patient with osteoarthritis of the knee receives a total knee replacement. The provider participates in the MVP program and reports G0058., A patient sustains a hip fracture and undergoes surgical repair. The provider, participating in the MVP, reports G0058., A patient undergoes ankle fracture repair.The orthopedic surgeon participates in the Lower Extremity Joint Repair MVP and reports G0058 to track quality measures.

Documentation should support the diagnosis and treatment provided within the scope of the Lower Extremity Joint Repair MVP. This includes documentation of the patient's condition, the decision-making process for treatment, the procedures performed, and any relevant post-operative care. Participation in the MVP may require additional documentation related to quality measures.

** The information provided is current as of December 1, 2024 and may be subject to change. Refer to CMS and other official resources for the most up-to-date information on MIPS Value Pathways and HCPCS code G0058.

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