How To Use HCPCS Code G9980

HCPCS code G9980 describes a remote in-home visit for the evaluation and management of a new patient. This code is specifically used in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. The visit must meet certain criteria, including the use of interactive audio and video technology for real-time communication with the patient. In this article, we will explore the details of HCPCS code G9980, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9980?

HCPCS code G9980 is used to identify a remote in-home visit for the evaluation and management of a new patient. This visit is conducted using interactive audio and video technology in real-time. The purpose of this visit is to provide medical care and counseling to the patient or their family, as needed. The presenting problem(s) during this visit are typically of moderate severity. The visit duration is approximately 30 minutes.

2. Official Description

The official description of HCPCS code G9980 is as follows: “Remote in-home visit for the evaluation and management of a new patient for use only in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low 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 severity. Typically, 30 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. A detailed history of the patient’s medical condition is obtained, including relevant information about their symptoms, medical history, and any previous treatments.
3. A detailed examination of the patient is conducted remotely, assessing their physical condition and any visible symptoms.
4. The provider performs medical decision making of low complexity based on the information gathered during the visit.
5. Counseling and coordination of care with other healthcare professionals or agencies are provided as necessary, considering the nature of the problem(s) and the needs of the patient or their family.
6. The visit typically lasts for approximately 30 minutes.

4. When to use HCPCS code G9980

HCPCS code G9980 should be used when conducting a remote in-home visit for the evaluation and management of a new patient. It is important to note that this code is only applicable in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. The visit must meet the specific criteria outlined in the official description, including the use of interactive audio and video technology for real-time communication with the patient.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9980, healthcare providers need to ensure that the visit meets the requirements outlined in the official description. Documentation should include a detailed history, a detailed examination, and medical decision making of low complexity. Additionally, providers should document any counseling and coordination of care provided to the patient or their family. It is important to accurately reflect the nature of the problem(s) and the needs of the patient or their family in the documentation.

6. Historical Information and Code Maintenance

HCPCS code G9980 was added to the Healthcare Common Procedure Coding System on October 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 G9980 is payable by Medicare. The pricing indicator code 13 indicates that the price for this code is established by carriers, based on carrier discretion. The multiple pricing indicator code A indicates that the code is not applicable as HCPCS priced under one methodology. It is important for healthcare providers to check with other insurance carriers to determine coverage and reimbursement policies for this specific code.

8. Examples

Here are five examples of when HCPCS code G9980 should be billed:

1. A new patient with moderate severity symptoms requires a remote in-home visit for evaluation and management. The visit lasts for approximately 30 minutes, and the provider utilizes interactive audio and video technology for real-time communication.
2. A Medicare beneficiary enrolled in the BPCI Advanced model episode of care needs a remote in-home visit for the evaluation and management of their medical condition. The visit includes a detailed history, examination, and medical decision making of low complexity.
3. A provider conducts a remote in-home visit for a new patient who is unable to travel to the healthcare facility due to mobility issues. The visit involves counseling and coordination of care with other healthcare professionals, as needed.
4. A patient with moderate severity symptoms requires a remote in-home visit for the evaluation and management of their medical condition. The visit includes a detailed examination and medical decision making of low complexity, conducted via interactive audio and video technology.
5. A provider conducts a remote in-home visit for a new patient enrolled in the BPCI Advanced model episode of care. The visit involves counseling and coordination of care with other healthcare professionals or agencies, based on the needs of the patient or their family.