How To Use HCPCS Code G9981

HCPCS code G9981 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 G9981, 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 G9981?

HCPCS code G9981 is a specific code 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, allowing for real-time communication between the healthcare provider and the patient. The purpose of this visit is to assess the patient’s condition, provide counseling and coordination of care, and make medical decisions of moderate complexity. The visit typically lasts for 45 minutes and is used within the context of a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care.

2. Official Description

The official description of HCPCS code G9981 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 comprehensive history; a comprehensive examination; medical decision making of moderate 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, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology.”

3. Procedure

1. The healthcare provider initiates the remote in-home visit using interactive audio and video technology.
2. The provider conducts a comprehensive history, gathering information about the patient’s medical background, current symptoms, and any relevant factors.
3. A comprehensive examination is performed, which may include visual assessments, physical examinations, and other diagnostic procedures that can be conducted remotely.
4. The provider engages in medical decision making of moderate complexity, considering the patient’s condition, test results, and other relevant factors.
5. Counseling and coordination of care with other healthcare professionals or agencies are provided as needed, based on the nature of the patient’s problems and their specific needs.
6. The visit typically lasts for 45 minutes and is conducted in real-time, with the provider and patient communicating through audio and video intercommunications technology.

4. When to use HCPCS code G9981

HCPCS code G9981 should be used when conducting a remote in-home visit for the evaluation and management of a new patient within the context of 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 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 HCPCS code G9981, healthcare providers need to ensure that they document the details of the remote in-home visit, including the comprehensive history, examination, medical decision making, counseling, and coordination of care provided. The documentation should clearly indicate the use of interactive audio and video technology for real-time communication with the patient. Additionally, providers should follow the billing guidelines set forth by Medicare and any other relevant insurance carriers to ensure proper reimbursement for the service.

6. Historical Information and Code Maintenance

HCPCS code G9981 was added to the Healthcare Common Procedure Coding System on October 01, 2018. 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. The code is priced based on carrier judgment, with the pricing indicator code 13, which signifies that the price is established by carriers. The code is categorized as a medical care service with no applicable anesthesia base unit quantity.

7. Medicare and Insurance Coverage

HCPCS code G9981 is payable by Medicare when used within the context of a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. The pricing for this code is established by carriers, and it is not priced under multiple methodologies. Other insurance carriers may have their own coverage policies for this code, so it is important to check with each individual carrier to determine coverage and reimbursement guidelines.

8. Examples

Here are five examples of scenarios in which HCPCS code G9981 should be billed:

1. A healthcare provider conducts a remote in-home visit for a new patient who has recently undergone surgery and requires post-operative evaluation and management.
2. A provider performs a comprehensive remote assessment of a new patient with a chronic condition, such as diabetes, to determine the appropriate treatment plan and provide counseling on self-management.
3. A healthcare professional conducts a remote visit with a new patient who is experiencing moderate to high severity symptoms and requires immediate evaluation and management.
4. A provider conducts a remote in-home visit for a new patient who is unable to travel to a healthcare facility due to mobility issues or geographic limitations.
5. A healthcare provider performs a comprehensive remote examination and evaluation of a new patient who requires ongoing monitoring and management of a complex medical condition.