2025 HCPCS code G9140
(Active) Effective Date: N/A Revision Date: N/A Professional Services - Frontier Extended Stay Clinic Services Medicare Demonstration Projects Feed
Covers a stay of four or more hours in a CMS-approved Frontier Extended Stay Clinic (FESC) for seriously ill patients unable to transfer to an acute care hospital due to extenuating circumstances.
Medical necessity for G9140 is established when a patient's condition requires observation and monitoring but immediate transport to an acute care hospital is impossible or clinically inappropriate. This is based on factors such as distance, weather, transportation availability, and the patient's overall clinical status.
Frontier Extended Stay Clinics are responsible for providing appropriate observation and monitoring services to patients meeting the criteria for this code. The attending physician is responsible for assessing the patient's condition and making clinical decisions. The clinic must maintain proper documentation as required by Medicare.
In simple words: This code pays for a stay of at least four hours in a special clinic far from a hospital. This clinic is for very sick people who can't get to a hospital right away because of problems like bad weather or no way to travel. The clinic can keep them for up to 48 hours.
This HCPCS code, G9140, reimburses for a minimum four-hour stay at a CMS-approved Frontier Extended Stay Clinic (FESC) for critically ill or injured patients who cannot be transported to an acute care hospital due to factors like severe weather or lack of transportation, or who don't meet CMS inpatient hospital admission criteria but require temporary monitoring.FESCs are located at least 75 miles from the nearest hospital.The clinic must not have more than four patients concurrently.The stay can be extended if continuous monitoring is needed, regardless of CMS inpatient criteria. Medicare only pays for stays of at least four hours.The clinic must document the provider's risk assessment and justification for observation care, including reasons for delayed transfer if applicable.This code is reported for each four-hour period up to a maximum of 48 hours.
Example 1: A patient is injured in a remote area during a blizzard.Due to impassable roads, the patient is transported to the nearest FESC. The patient remains at the FESC for 12 hours requiring continuous monitoring. Three units of G9140 would be billed., A patient lives 100 miles from the nearest hospital and experiences a serious medical event requiring immediate attention. Due to a lack of available transportation options, the patient goes to the FESC for a six-hour observation period. This necessitates billing two units of G9140., An elderly patient living in a remote location experiences a sudden decline in health, and transport to a hospital is delayed due to logistical issues.They are admitted to the FESC and undergo observation and treatment for 20 hours before being transferred to the hospital.Five units of G9140 would be billed.
* Documentation of the patient's condition and the need for observation and monitoring.* Documentation of the reasons why the patient could not be transported to an acute care hospital.* Documentation of the services provided during the stay at the FESC.* Detailed records of patient vital signs, clinical findings, medications administered, treatments given, and provider notes.
** This code is specific to CMS-approved Frontier Extended Stay Clinics and is subject to the terms and conditions of the demonstration project.Reimbursement is contingent on adherence to all program guidelines and the submission of appropriate documentation.
- Global Days : Up to 48 hours, billed in four-hour increments.
- Payment Status: Active
- Specialties:Emergency Medicine, Rural Health
- Place of Service:Rural Health Clinic