How To Use HCPCS Code G1017

HCPCS code G1017 describes a clinical decision support mechanism called HealthHelp, which is defined by the Medicare Appropriate Use Criteria (AUC) program. This code is used to identify the use of HealthHelp as a tool to assist healthcare providers in making appropriate clinical decisions for their patients.

1. What is HCPCS G1017?

HCPCS code G1017 is a specific code that represents the use of the clinical decision support mechanism HealthHelp. This code is used to indicate that a healthcare provider has utilized HealthHelp to aid in their decision-making process when determining the appropriate course of treatment for a patient.

2. Official Description

The official description of HCPCS code G1017 is “Clinical decision support mechanism HealthHelp, as defined by the Medicare Appropriate Use Criteria program.” The short description for this code is “Cdsm HealthHelp.”

3. Procedure

1. The healthcare provider accesses the HealthHelp system.
2. The provider enters the patient’s relevant medical information into the system.
3. The system analyzes the data and provides evidence-based recommendations or guidelines for the provider to consider.
4. The provider reviews the recommendations and incorporates them into their clinical decision-making process.
5. The provider determines the appropriate course of treatment based on the information provided by HealthHelp.

4. When to use HCPCS code G1017

HCPCS code G1017 should be used when a healthcare provider utilizes the HealthHelp clinical decision support mechanism to assist in making appropriate clinical decisions for their patients. This code is used to indicate that HealthHelp was utilized as a tool in the decision-making process.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G1017, healthcare providers should ensure that they have documented the use of HealthHelp in the patient’s medical record. This documentation should include the date and time of the HealthHelp consultation, as well as any relevant information or recommendations provided by the system. Providers should also follow any specific billing guidelines or requirements set forth by their insurance carriers or Medicare.

6. Historical Information and Code Maintenance

HCPCS code G1017 was added to the Healthcare Common Procedure Coding System on April 01, 2020. As of this date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G1017 may vary depending on the insurance carrier or Medicare. Providers should check with their specific insurance carriers or Medicare to determine if this code is payable. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled or not covered by Medicare or other insurers.

8. Examples

Here are five examples of when HCPCS code G1017 may be billed:

1. A primary care physician uses HealthHelp to determine the appropriate imaging study for a patient with lower back pain.
2. An orthopedic surgeon consults HealthHelp to guide their decision-making process when considering surgical options for a patient with a complex fracture.
3. A cardiologist utilizes HealthHelp to assist in determining the appropriate medication regimen for a patient with heart failure.
4. An oncologist accesses HealthHelp to review evidence-based treatment guidelines for a patient with a specific type of cancer.
5. A psychiatrist incorporates HealthHelp recommendations into their treatment plan for a patient with a complex psychiatric condition.