How To Use HCPCS Code G2077

HCPCS code G2077 describes the periodic assessment provided by qualified personnel to determine the most appropriate combination of services and treatment for patients in a Medicare-enrolled opioid treatment program. This code is used to identify and bill for the periodic assessment separately in addition to the primary procedure code.

1. What is HCPCS G2077?

HCPCS code G2077 is a specific code used in medical coding to identify and bill for the periodic assessment provided by qualified personnel in a Medicare-enrolled opioid treatment program. This assessment is conducted periodically to determine the most appropriate combination of services and treatment for patients. It is important to note that this code should be listed separately in addition to the primary procedure code.

2. Official Description

The official description of HCPCS code G2077 is “Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a Medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure.” The short description for this code is “Periodic assessment.”

3. Procedure

1. The periodic assessment procedure involves the assessment of patients by qualified personnel in a Medicare-enrolled opioid treatment program.
2. The assessment is conducted periodically to evaluate the patient’s progress, determine the effectiveness of the current treatment plan, and identify any necessary adjustments or modifications.
3. Qualified personnel, such as healthcare professionals with expertise in opioid treatment, perform a comprehensive evaluation of the patient’s condition, including physical, mental, and social aspects.
4. During the assessment, the healthcare provider may review the patient’s medical history, conduct physical examinations, perform laboratory tests, and assess the patient’s response to the current treatment.
5. Based on the assessment findings, the qualified personnel determine the most appropriate combination of services and treatment for the patient, considering factors such as the severity of the opioid use disorder, co-occurring conditions, and individual patient needs.
6. The periodic assessment is an essential component of the overall treatment plan and helps ensure that patients receive the most effective and appropriate care.

4. When to use HCPCS code G2077

HCPCS code G2077 should be used when healthcare providers perform the periodic assessment for patients in a Medicare-enrolled opioid treatment program. This code is specifically for assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment. It is important to list this code separately in addition to the primary procedure code to ensure accurate billing and reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G2077, healthcare providers need to ensure proper documentation to support the services provided. The documentation should include:

• Documentation of the periodic assessment performed by qualified personnel
• Details of the assessment findings and the rationale for the chosen combination of services and treatment
• Documentation of the patient’s progress and response to the current treatment
• Any adjustments or modifications made to the treatment plan based on the assessment

Proper documentation is crucial for accurate billing and to demonstrate the medical necessity of the periodic assessment.

6. Historical Information and Code Maintenance

HCPCS code G2077 was added to the Healthcare Common Procedure Coding System on January 01, 2020. As of its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important for medical coders and healthcare providers to stay updated on any changes or revisions related to this code.

7. Medicare and Insurance Coverage

HCPCS code G2077 is covered by Medicare. The pricing indicator code 13 indicates that the price for this code is established by carriers, which means it is not otherwise classified and is subject to individual determination and carrier discretion. The multiple pricing indicator code A indicates that it is not applicable as HCPCS priced under one methodology.

8. Examples

Here are some examples of when HCPCS code G2077 should be billed:

1. A patient in a Medicare-enrolled opioid treatment program undergoes a periodic assessment by qualified personnel to evaluate their progress and determine the most appropriate combination of services and treatment.
2. A healthcare provider performs a periodic assessment for a patient with an opioid use disorder, reviewing their medical history, conducting physical examinations, and assessing their response to the current treatment.
3. Qualified personnel in an opioid treatment program conduct a periodic assessment for a patient with co-occurring conditions, considering their individual needs and adjusting the treatment plan accordingly.
4. A patient in a Medicare-enrolled opioid treatment program receives a periodic assessment to ensure the ongoing effectiveness of the current treatment and make any necessary modifications.
5. A healthcare provider performs a periodic assessment for a patient in an opioid treatment program, documenting the assessment findings and the rationale for the chosen combination of services and treatment.