Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.28
    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0175-interdisciplinary-team-conference-patient-present
    Ask Trek AI about this page

    HCPCS G0175: Scheduled Interdisciplinary Team Conference with Patient Present

    HCPCS Level II code G0175 denotes a scheduled interdisciplinary team conference with the patient present, requiring a minimum of three team members (excluding patient care nursing staff); the service is an interdisciplinary care conference typically provided in skilled nursing facilities or nursing facility settings for coordinated care planning and review of the patient’s clinical status and goals of care.

    For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease.

    Customize your policy alerts

    Sign up for hcpcs G0175 policy alerts

    Get alerted when payer policies referencing G0175 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    National Reimbursement Benchmarks

    National commercial pricing for HCPCS G0175 centers on a BUCA average of $160.10, with notable divergence among major carriers. Blue Cross Blue Shield exhibits a wide mid‑distribution spread (P75 $266.30 minus P25 $28.10 = $238.20), and UnitedHealth Group shows the largest dispersion (P75 $678.10 minus P25 $45.50 = $632.60), reflecting substantial variability in negotiated commercial payments. Cigna and Aetna are relatively tighter: Cigna’s spread is $82.70 minus $46.00 = $36.70, while Aetna’s interquartile span is $65.00 minus $33.00 = $32.00, indicating more consistency around their medians.

    Maximum and minimum extremes amplify the picture for carriers that publish them. UnitedHealth Group also posts the highest single maximum at $1,985.70, while Blue Cross Blue Shield reaches $450.00; Aetna’s maximum is $376.00. Cigna’s capped maximum of $135.20 contrasts with the higher averages and dispersions of Blue Cross Blue Shield, BUCA, and UnitedHealth Group, suggesting payer-specific contracting strategies drive a broad marketplace distribution.

    Table of contents

    Progress1 / 8

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 82-year-old resident of a skilled nursing facility with known F03.90 (unspecified dementia without behavioral disturbance) and intermittent R41.82 (altered mental status, unspecified) is scheduled for a planned interdisciplinary team conference billed with G0175. The conference is convened at the facility with the patient present and includes at least three disciplines exclusive of patient-care nursing staff (for example: geriatric medicine physician, geriatric nurse practitioner, and psychiatry/neurology physician). The meeting addresses cognitive decline, medication reconciliation, fall risk mitigation, advance care planning, and coordination of specialist referrals. Clinical workflow: the facility social worker or case manager sends the meeting request; participants review the chart and recent labs/consult notes in advance; the team meets at the bedside or in a private room with the patient present to review findings, assess decision-making capacity, align goals of care, and document the interdisciplinary plan in the medical record. Billing for G0175 is recorded on the date the conference occurs, with appropriate supporting documentation of attendees (roles noted), topics addressed, time/date/location, the patient’s presence, and sign-in or progress-note documentation summarizing agreed care plans and follow-up actions.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207QG0300XGeriatric Medicine (Family Medicine) PhysicianA family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitati…
    163WG0000XGeneral Practice Registered NurseNursing Service Providers · Registered Nurse
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    246YR1600XRegistered Record AdministratorNone
    224900000XMastectomy FitterAn individual trained in the fitting and adjusting of breast prostheses and management of post-mastectomy prostheses services.
    207SM0001XMolecular Genetic Pathology (Medical Genetics) PhysicianA board certified subspecialty, the molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecu…
    225XM0800XMental Health Occupational TherapistOccupational therapists provide treatment for people recovering from a mental or physical illness to regain their independence and stability and to en…
    2279P1005XPulmonary Rehabilitation Registered Respiratory TherapistThe respiratory therapist can assist the chronic pulmonary patient in returning to an optimal role in society by providing an effective program. It i…

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01
    Celiac Disease TestingOscar Health2026-10-01
    Laboratory Testing for the Diagnosis of Inflammatory Bowel DiseaseOscar Health2026-10-01
    Percutaneous Electrical Nerve Field Stimulation (PENFS)Cigna2026-09-15
    Colorectal Cancer ScreeningBlue Cross Blue Shield - New Mexico2026-09-04

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

    HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

    HCPCS G0008: Administration of Influenza Virus Vaccine

    HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

    HCPCS G0009: Administration of Pneumococcal Vaccine

    HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

    HCPCS G0010: Administration of Hepatitis B Vaccine

    HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

    HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

    HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

    HCPCS G0012: Injection of PrEP Drug for HIV Prevention

    HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

    HCPCS G0013: Individual PrEP Counseling by Clinical Staff

    HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

    HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

    HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

    HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

    HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

    HCPCS G0019: Community Health Integration, Person-Centered Assessment

    Showing 1–10 of 1996

    • More pages

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    99304Initial nursing facility care, per day, for the evaluation and management of a patientMay be performed on admission to the facility prior to scheduling an interdisciplinary conference; documents baseline E/M care
    99305Initial nursing facility care, per day, for the evaluation and management of a patientHigher-complexity initial E/M that may precede or complement G0175 when complex issues require the conference
    99306Initial nursing facility care, per day, for the evaluation and management of a patientHighest-complexity initial nursing facility E/M that can accompany interdisciplinary planning billed with G0175 when separately identifiable
    99307Subsequent nursing facility care, per day, for the evaluation and management of a patientCommon follow-up E/M in the facility; may be billed same day if separately documented from the conference content
    99308Subsequent nursing facility care, per day, for the evaluation and management of a patientLower complexity subsequent E/M; use when patient follow-up is distinct from the interdisciplinary conference content