How To Use HCPCS Code G9985

HCPCS code G9985 describes a remote in-home visit for the evaluation and management of an established 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, and the provision of at least two of the following three key components: a detailed history, a detailed examination, and medical decision making of moderate complexity. The visit typically lasts for 25 minutes and involves counseling and coordination of care with other healthcare professionals or agencies, as needed.

1. What is HCPCS G9985?

HCPCS code G9985 is a specific code used to identify a remote in-home visit for the evaluation and management of an established patient. It is used in the context of a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. This code signifies that the visit was conducted using interactive audio and video technology and involved at least two of the following three key components: a detailed history, a detailed examination, and medical decision making of moderate complexity. The visit typically lasts for 25 minutes and includes counseling and coordination of care with other healthcare professionals or agencies, as necessary.

2. Official Description

The official description of HCPCS code G9985 is as follows: “Remote in-home visit for the evaluation and management of an established patient for use only in a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care, which requires at least 2 of the following 3 key components: a detailed history; a detailed 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, 25 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology.”

3. Procedure

1. The provider initiates a remote in-home visit with an established patient using interactive audio and video technology.
2. The provider conducts a detailed history, which involves gathering information about the patient’s medical background, current symptoms, and any relevant factors that may impact their healthcare.
3. The provider performs a detailed examination, assessing the patient’s physical condition and any specific areas of concern.
4. The provider engages in medical decision making of moderate complexity, evaluating the patient’s symptoms, test results, and treatment options to determine the appropriate course of action.
5. During the visit, the provider also provides counseling and coordination of care with other physicians, qualified healthcare professionals, or agencies, as needed.
6. The visit typically lasts for 25 minutes and is conducted in real time via audio and video intercommunications technology.

4. When to use HCPCS code G9985

HCPCS code G9985 should be used when a healthcare provider conducts a remote in-home visit for the evaluation and management of an established patient. This code is specifically used in the context of a Medicare-approved bundled payments for care improvement advanced (BPCI Advanced) model episode of care. The visit must meet the criteria outlined in the official description, including the use of interactive audio and video technology and the provision of at least two of the three key components: a detailed history, a detailed examination, and medical decision making of moderate 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 G9985, healthcare providers need to document the following:

• The use of interactive audio and video technology for the remote in-home visit.
• The time spent with the patient or family, which should be at least 25 minutes.
• The provision of at least two of the three key components: a detailed history, a detailed examination, and medical decision making of moderate complexity.
• The counseling and coordination of care with other physicians, qualified healthcare professionals, or agencies, as appropriate.
• The nature of the problem(s) presented by the patient, which are typically of moderate to high severity.

6. Historical Information and Code Maintenance

HCPCS code G9985 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.

7. Medicare and Insurance Coverage

HCPCS code G9985 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 signifies that the code is not applicable as HCPCS priced under one methodology. Other insurers may also provide coverage for this service, but it is important to check with individual insurance plans for specific coverage details.

8. Examples

Here are five examples of scenarios in which HCPCS code G9985 should be billed:

1. A healthcare provider conducts a remote in-home visit with an established patient using interactive audio and video technology. The visit lasts for 25 minutes and includes a detailed history, a detailed examination, and medical decision making of moderate complexity. The provider also provides counseling and coordination of care with other healthcare professionals to address the patient’s moderate to high severity health issues.
2. A patient with a chronic condition requires regular evaluation and management. The healthcare provider conducts a remote in-home visit using interactive audio and video technology. The visit lasts for 25 minutes and includes a detailed history, a detailed examination, and medical decision making of moderate complexity. The provider also coordinates care with other healthcare professionals to ensure the patient’s ongoing treatment plan is effective.
3. An established patient experiences a sudden change in symptoms and requires immediate evaluation and management. The healthcare provider conducts a remote in-home visit using interactive audio and video technology. The visit lasts for 25 minutes and includes a detailed history, a detailed examination, and medical decision making of moderate complexity. The provider also provides counseling and coordination of care with other healthcare professionals to address the patient’s urgent health concerns.
4. A patient recovering from a surgical procedure needs regular follow-up care. The healthcare provider conducts a remote in-home visit using interactive audio and video technology. The visit lasts for 25 minutes and includes a detailed history, a detailed examination, and medical decision making of moderate complexity. The provider also coordinates care with other healthcare professionals to ensure the patient’s recovery progress is monitored and any necessary adjustments to the treatment plan are made.
5. An established patient with multiple chronic conditions requires comprehensive evaluation and management. The healthcare provider conducts a remote in-home visit using interactive audio and video technology. The visit lasts for 25 minutes and includes a detailed history, a detailed examination, and medical decision making of moderate complexity. The provider also provides counseling and coordination of care with other healthcare professionals to address the patient’s complex healthcare needs.