Browse HCPCS Level II 2020 Edition

HCPCS Level II Table of Contents

G0068 - G0087  Administration, Payment and Care Management Services

G0068
Professional services for the administration of anti-infective, pain management, chelation, pulmonary hypertension, and/or inotropic infusion drug(s) for each infusion drug administration calendar day in the individual's home, each 15 minutes
shortAdm of infusion drug in home
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA16.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
OPH16.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
G0069
Professional services for the administration of subcutaneous immunotherapy for each infusion drug administration calendar day in the individual's home, each 15 minutes
shortAdm of immune drug in home
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA16.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
OPH16.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
G0070
Professional services for the administration of chemotherapy for each infusion drug administration calendar day in the individual's home, each 15 minutes
shortAdm of chemo drug in home
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.00.00.00.00.00.0XXX
MUE
LocationValueAjudication IndicatorRationale
PRA16.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
OPH16.03 Date of Service Edit: ClinicalClinical: CMS Workgroup
G0071
Payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an rural health clinic (rhc) or federally qualified health center (fqhc) practitioner and rhc or fqhc patient, or 5 minutes or more of remote evaluation of recorded video and/or images by an rhc or fqhc practitioner, occurring in lieu of an office visit; rhc or fqhc only
shortComm svcs by rhc/fqhc 5 min
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
0.220.080.140.020.320.38XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0076
Brief (20 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare manag h vst new pt 20 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
1.010.480.480.091.581.58XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0077
Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare manag h vst new pt 30 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
1.520.610.610.122.252.25XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0078
Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare manag h vst new pt 45 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
2.530.970.970.213.713.71XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0079
Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare manag h vst new pt 60 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
3.381.551.550.275.25.2XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0080
Extensive (75 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare manag h vst new pt 75 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
4.091.91.90.326.316.31XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0081
Brief (20 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare man h v ext pt 20 mi
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
1.00.490.490.091.581.58XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0082
Limited (30 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare man h v ext pt 30 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
1.560.720.720.122.42.4XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0083
Moderate (45 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare man h v ext pt 45 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
2.331.171.170.183.683.68XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0084
Comprehensive (60 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare man h v ext pt 60 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
3.281.561.560.275.115.11XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0085
Extensive (75 minutes) care management home visit for an existing patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare man h v ext pt 75 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
4.091.91.90.326.316.31XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0086
Limited (30 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare man home care plan 30 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
1.250.850.850.092.192.19XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure
G0087
Comprehensive (60 minutes) care management home care plan oversight. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
shortCare man home care plan 60 m
RVU
CPT ModifierPhysician ComponentFacility PracticeNonfacility PracticeProfessional Liability InsuranceTotal FacilityTotal NonfacilityGlobal Period
1.81.121.120.133.053.05XXX
MUE
LocationValueAjudication IndicatorRationale
PRA1.03 Date of Service Edit: ClinicalNature of Service/Procedure
OPH1.03 Date of Service Edit: ClinicalNature of Service/Procedure