How To Use HCPCS Code G9484

HCPCS code G9484 describes a remote in-home visit for the evaluation and management of a new patient. This code is specifically used in a Medicare-approved CMS Innovation Center demonstration project. The visit is conducted using interactive audio and video technology, allowing for real-time communication between the healthcare provider and the patient. The purpose of this article is to provide a comprehensive understanding of HCPCS code G9484, including its official description, procedure, when to use it, billing guidelines, historical information, and Medicare and insurance coverage.

1. What is HCPCS G9484?

HCPCS code G9484 is a unique code used to identify a specific medical service. In this case, it represents a remote in-home visit for the evaluation and management of a new patient. The visit is conducted using interactive audio and video technology, allowing for real-time communication between the healthcare provider and the patient. This code is only applicable in a Medicare-approved CMS Innovation Center demonstration project.

2. Official Description

The official description of HCPCS code G9484 is as follows: “Remote e/m new pt 45mins.” This description indicates that the code represents a remote evaluation and management visit for a new patient, with a duration of 45 minutes.

3. Procedure

1. The healthcare provider initiates the remote in-home visit using interactive audio and video technology.
2. The provider collects a comprehensive history from the patient, gathering information about their medical background, symptoms, and any relevant factors.
3. A comprehensive examination is conducted, which may involve visual observation, verbal communication, and assessment of physical signs.
4. The provider engages in medical decision making of moderate complexity, considering the patient’s symptoms, medical history, and any diagnostic tests or procedures that may be required.
5. Counseling and coordination of care with other physicians, qualified healthcare professionals, or agencies are provided as needed, based on the nature of the patient’s problem(s) and their specific needs.
6. The presenting problem(s) are typically of moderate to high severity.
7. The entire visit lasts for approximately 45 minutes, during which the provider interacts with the patient and/or their family in real time through audio and video intercommunications technology.

4. When to use HCPCS code G9484

HCPCS code G9484 should be used in the context of a Medicare-approved CMS Innovation Center demonstration project. It is specifically intended for remote in-home visits for the evaluation and management of new patients. The visit must meet the criteria outlined in the official description, including the comprehensive history, examination, and medical decision making of moderate complexity. The presenting problem(s) should be of moderate to high severity.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9484, healthcare providers need to ensure proper documentation. This includes recording the comprehensive history obtained from the patient, documenting the comprehensive examination conducted, and detailing the medical decision making process. Additionally, providers should document any counseling and coordination of care provided to the patient or their family. It is important to accurately capture the duration of the visit, which should be approximately 45 minutes. Proper documentation is crucial for accurate billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9484 was added to the Healthcare Common Procedure Coding System on April 01, 2016. As of January 01, 2018, 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 to stay updated on any changes or revisions to HCPCS codes to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

HCPCS code G9484 is covered by Medicare. However, it is important to note that the pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the service may be bundled or not covered under certain circumstances. It is essential to review Medicare guidelines and policies to determine the specific coverage and reimbursement for this code. For other insurance providers, coverage and reimbursement may vary, so it is important to consult the respective payer’s guidelines.

8. Examples

Here are five examples of scenarios in which HCPCS code G9484 may be used:

1. A healthcare provider conducts a remote in-home visit for a new patient who is experiencing moderate to high severity symptoms. The visit lasts for approximately 45 minutes, during which the provider collects a comprehensive history, performs a comprehensive examination, engages in medical decision making of moderate complexity, and provides counseling and coordination of care as needed.
2. A patient enrolled in a Medicare-approved CMS Innovation Center demonstration project requires an evaluation and management visit. Due to mobility limitations, the patient is unable to visit the healthcare facility in person. The provider conducts a remote in-home visit using interactive audio and video technology, following the criteria outlined in HCPCS code G9484.
3. A new patient seeks medical advice and evaluation for a complex medical condition. The provider, located in a different geographical area, conducts a remote in-home visit using interactive audio and video technology. The visit meets the requirements specified in HCPCS code G9484, including the comprehensive history, examination, and medical decision making of moderate complexity.
4. A patient with multiple chronic conditions requires ongoing evaluation and management. The provider conducts regular remote in-home visits using interactive audio and video technology, ensuring that the criteria outlined in HCPCS code G9484 are met during each visit.
5. A healthcare provider participates in a Medicare-approved CMS Innovation Center demonstration project and offers remote in-home visits as part of the project. The provider follows the guidelines and requirements set forth in HCPCS code G9484 when conducting these visits.