How To Use HCPCS Code G9964

HCPCS code G9964 describes the scenario where a patient has received at least one well-child visit with a primary care physician (PCP) during the performance period. This code is used to identify and bill for the specific service provided, ensuring accurate reimbursement and documentation.

1. What is HCPCS G9964?

HCPCS code G9964 is a specific code used in medical coding to represent a well-child visit with a PCP. It is important to note that this code is only applicable when the patient has received at least one well-child visit during the performance period. The purpose of using this code is to accurately document and track the provision of well-child visits, ensuring appropriate reimbursement and monitoring of healthcare services.

2. Official Description

The official description of HCPCS code G9964 is “Patient received at least one well-child visit with a PCP during the performance period.” The short description for this code is “Pt recv >=1 well-chld visit.”

3. Procedure

1. The provider schedules a well-child visit with the patient.
2. During the visit, the PCP performs a comprehensive assessment of the child’s health, including physical examination, developmental screening, and immunization review.
3. The PCP discusses any concerns or questions with the patient or their parents/guardians.
4. Based on the assessment, the PCP provides appropriate preventive care, counseling, and education to promote the child’s overall health and well-being.
5. The PCP documents the details of the well-child visit, including the services provided, findings, and any recommendations for follow-up care.

4. When to use HCPCS code G9964

HCPCS code G9964 should be used when a patient has received at least one well-child visit with a PCP during the performance period. It is important to ensure that the visit meets the criteria for a well-child visit, including the provision of comprehensive assessment, preventive care, and counseling. This code should not be used for other types of visits or services unrelated to well-child care.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9964, healthcare providers need to ensure accurate documentation of the well-child visit. This includes documenting the services provided, such as physical examination, developmental screening, immunization review, and any counseling or education provided. It is important to include relevant details, findings, and recommendations for follow-up care in the medical record.

6. Historical Information and Code Maintenance

HCPCS code G9964 was added to the Healthcare Common Procedure Coding System on 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. This code is still currently active and in use.

7. Medicare and Insurance Coverage

The coverage of HCPCS code G9964 may vary depending on the specific insurance provider. Medicare coverage for this code is determined by the carrier judgment, indicated by the coverage code C. It is important for healthcare providers to verify the coverage and reimbursement policies of each insurance carrier to ensure proper billing and reimbursement.

8. Examples

Here are five examples of scenarios where HCPCS code G9964 should be billed:

1. A 2-year-old child visits their PCP for a well-child visit, where they receive a physical examination, developmental screening, and immunization review.
2. A 5-year-old child has their annual well-child visit with their PCP, during which the PCP provides counseling on nutrition and safety.
3. A 10-year-old child visits their PCP for a well-child visit, where the PCP performs a physical examination, discusses puberty-related concerns, and provides appropriate counseling.
4. A 1-year-old child visits their PCP for a well-child visit, during which the PCP administers necessary immunizations and discusses age-appropriate milestones.
5. A 7-year-old child has their well-child visit with their PCP, where the PCP performs a physical examination, provides counseling on healthy habits, and reviews the child’s growth chart.