How To Use HCPCS Code G2098

HCPCS code G2098 describes the specific criteria for patients who are 66 years of age and older and have at least one claim or encounter for frailty during the measurement period. In addition, these patients must have been dispensed a medication for dementia either during the measurement period or within the year prior to the measurement period. This code is used to identify and bill for the services provided to these patients.

1. What is HCPCS G2098?

HCPCS code G2098 is a specific code that is used to identify and bill for patients who meet the criteria of being 66 years of age and older, having a claim or encounter for frailty, and being dispensed a medication for dementia. This code helps healthcare providers accurately document and bill for the services provided to these patients.

2. Official Description

The official description of HCPCS code G2098 is as follows: “Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period.” The short description for this code is “Pt 66+ frailty and med dem.”

3. Procedure

1. Identify patients who are 66 years of age and older.
2. Review the patient’s medical records to determine if there is at least one claim or encounter for frailty during the measurement period.
3. Check the patient’s medication history to confirm if they have been dispensed a medication for dementia during the measurement period or within the year prior to the measurement period.
4. If the patient meets all the criteria, assign HCPCS code G2098 to accurately document and bill for the services provided.

4. When to use HCPCS code G2098

HCPCS code G2098 should be used when a patient who is 66 years of age and older has at least one claim or encounter for frailty during the measurement period and has been dispensed a medication for dementia during the measurement period or within the year prior to the measurement period. It is important to ensure that all the criteria are met before assigning this code.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G2098, healthcare providers need to document the patient’s age, the claim or encounter for frailty, and the dispensing of a medication for dementia. This documentation is essential for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G2098 was added to the Healthcare Common Procedure Coding System on January 01, 2020. As of the effective 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

Medicare and other insurance providers may cover services billed with HCPCS code G2098. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This could be due to the service being bundled with other services or not covered under Part B. The multiple pricing indicator code is 9, which indicates that the value for pricing this code is not established. It is important to check with the specific insurance provider for coverage and reimbursement details.

8. Examples

Here are five examples of when HCPCS code G2098 should be billed:

1. A 70-year-old patient has a claim for frailty during the measurement period and has been dispensed a medication for dementia within the year prior to the measurement period.
2. A 68-year-old patient has multiple encounters for frailty during the measurement period and has been dispensed a medication for dementia during the measurement period.
3. A 72-year-old patient has a claim for frailty during the measurement period and has been dispensed multiple medications for dementia within the year prior to the measurement period.
4. A 66-year-old patient has a claim for frailty during the measurement period and has been dispensed a medication for dementia during the measurement period.
5. A 75-year-old patient has a claim for frailty during the measurement period and has been dispensed a medication for dementia within the year prior to the measurement period.