How To Use HCPCS Code G9489

HCPCS code G9489 describes a remote in-home visit for the evaluation and management of an established patient. This code is specifically used in a Medicare-approved COMS Innovation Center demonstration project. The visit must meet certain criteria, including the use of interactive audio and video technology in real time and the provision of at least two of the following three key components: a comprehensive history, a comprehensive examination, and medical decision making of high complexity. The visit typically lasts for 40 minutes and involves counseling and coordination of care with other healthcare professionals or agencies, as needed.

1. What is HCPCS G9489?

HCPCS code G9489 is a specific code used to identify a remote in-home visit for the evaluation and management of an established patient. It is only applicable in a Medicare-approved COMS Innovation Center demonstration project. This code is used when the visit meets certain criteria, including the use of interactive audio and video technology in real time and the provision of at least two of the following three key components: a comprehensive history, a comprehensive examination, and medical decision making of high complexity. The visit typically lasts for 40 minutes and involves counseling and coordination of care with other healthcare professionals or agencies, as needed.

2. Official Description

The official description of HCPCS code G9489 is “Remote in-home visit for the evaluation and management of an established patient for use only in a Medicare-approved COMS Innovation Center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. Counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology.”

3. Procedure

1. The provider initiates the remote in-home visit using interactive audio and video technology.
2. The provider reviews the patient’s medical history and conducts a comprehensive examination, if necessary.
3. The provider engages in medical decision making of high complexity, considering the nature of the patient’s problem(s) and their severity.
4. The provider spends approximately 40 minutes with the patient or family, providing counseling and coordination of care with other healthcare professionals or agencies, as needed.
5. The visit is conducted in real time, ensuring that the provider and patient can communicate and interact effectively.

4. When to use HCPCS code G9489

HCPCS code G9489 should be used when a healthcare provider is conducting a remote in-home visit for the evaluation and management of an established patient. However, it is important to note that this code is only applicable in a Medicare-approved COMS Innovation Center demonstration project. The visit must meet specific criteria, including the use of interactive audio and video technology in real time and the provision of at least two of the following three key components: a comprehensive history, a comprehensive examination, and medical decision making of high complexity. The presenting problem(s) during the visit are typically of moderate to high severity.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9489, healthcare providers need to ensure that they document the following:

• The use of interactive audio and video technology in real time for the remote in-home visit.
• The provision of at least two of the following three key components: a comprehensive history, a comprehensive examination, and medical decision making of high complexity.
• The duration of the visit, which should be approximately 40 minutes.
• The counseling and coordination of care provided with other healthcare professionals or agencies, as needed.
• The nature and severity of the patient’s problem(s) that were addressed during the visit.

6. Historical Information and Code Maintenance

HCPCS code G9489 was added to the Healthcare Common Procedure Coding System on April 01, 2016. It has an effective date of January 01, 2018. As of now, 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

HCPCS code G9489 is payable by Medicare. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This indicates that the service is either not covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means that it is not applicable as HCPCS is not priced separately by Part B or the value is not established. It is important for healthcare providers to check with other insurers regarding coverage and pricing for this specific code.

8. Examples

Here are five examples of when HCPCS code G9489 should be billed:

1. A healthcare provider conducts a remote in-home visit for an established patient using interactive audio and video technology. The visit includes a comprehensive history, a comprehensive examination, and medical decision making of high complexity. The provider spends 40 minutes with the patient, providing counseling and coordination of care with other healthcare professionals.
2. A healthcare provider conducts a remote in-home visit for an established patient using interactive audio and video technology. The visit includes a comprehensive history and medical decision making of high complexity. The provider spends 40 minutes with the patient, providing counseling and coordination of care with other healthcare professionals.
3. A healthcare provider conducts a remote in-home visit for an established patient using interactive audio and video technology. The visit includes a comprehensive examination and medical decision making of high complexity. The provider spends 40 minutes with the patient, providing counseling and coordination of care with other healthcare professionals.
4. A healthcare provider conducts a remote in-home visit for an established patient using interactive audio and video technology. The visit includes a comprehensive history and a comprehensive examination. The provider spends 40 minutes with the patient, providing counseling and coordination of care with other healthcare professionals.
5. A healthcare provider conducts a remote in-home visit for an established patient using interactive audio and video technology. The visit includes a comprehensive examination and medical decision making of high complexity. The provider spends 40 minutes with the patient, providing counseling and coordination of care with other healthcare professionals.