2025 HCPCS code G9984
Remote in-house evaluation and management assessment by a provider for an established patient in a BPCI Advanced model episode, requiring an expanded problem-focused history and examination and medical decision-making of low complexity (approx. 15 minutes).
Medical necessity must be established for the remote service. The documentation should clearly demonstrate the reason the remote assessment was necessary and appropriate for the patient's condition within the context of their BPCI Advanced episode of care. It should also explain why a face-to-face visit was not required.
The healthcare provider communicates with the patient and/or the patient’s family interactively regarding a problem of low to moderate severity. The visit requires an expanded problem-focused history and examination, as well as medical decision-making of low complexity, typically taking 15 minutes. Two of these three key components must be met to support the service level. This service could include patient assessment of functional status, medication review, assessment of treatment adherence, patient education, communication and coordination with other clinicians, and care management to improve connections to community and other services.
In simple words: This code covers a roughly 15-minute virtual check-in (via phone or video) with a healthcare professional for established patients enrolled in a specific Medicare program (BPCI Advanced). The visit addresses minor to moderate health issues and requires certain levels of examination, history, and medical decision-making.
This code describes an evaluation and management (E/M) visit of an established patient, typically lasting about 15 minutes, that a provider renders using real-time interactive audio and/or video communication methods such as the telephone or an Internet teleconference. The consultation may be with the patient and/or the patient's family and is reportable only for patients in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care whose problems are of low to moderate severity. The consultation must include two of the following: an expanded problem-focused history and physical examination and medical decision-making of low complexity.
Example 1: A patient enrolled in BPCI Advanced has a minor flare-up of a chronic skin condition. The physician conducts a 15-minute telehealth visit to assess the condition, review medication adherence, and adjust treatment as needed., An established patient in BPCI Advanced experiences a slightly elevated blood pressure. Their care provider performs a remote assessment, including review of recent blood pressure readings and symptoms, and provides guidance on medication management and lifestyle adjustments., A patient participating in BPCI Advanced expresses concerns about side effects from recently prescribed medication. The physician performs a telehealth visit to discuss these concerns, evaluate adherence to the treatment plan, and make modifications if necessary.
Documentation should support the time spent (approximately 15 minutes), the interactive communication method used, the patient's participation in a BPCI Advanced episode, and the medical necessity of the remote encounter. This includes details of the expanded problem-focused history, physical examination (if performed), and medical decision-making. It should also reflect the patient's condition and the complexity of the assessment and any changes made to the treatment plan.
- Payment Status: Active
- Place of Service:Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home