Summary & Overview
HCPCS G0076: Brief Care Management Home Visit for New Patient
HCPCS Level II code G0076 designates a brief, 20-minute care management home visit for a new patient delivered under a Medicare-approved CMMI model. The code is specific to care management services provided within a beneficiary's residence or residential care setting and is relevant for programs aiming to coordinate care and reduce avoidable acute utilization among high-risk populations. Nationally, the code matters because it defines a discrete, time-based service in alternative payment model contexts and sets expectations for documentation and site-of-service eligibility.
Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical and operational scope, typical settings where the service applies, and what to expect in benchmarking and policy discussions. The publication covers national benchmarks where available, recent policy updates affecting model-based care management visits, and the clinical context for using time-limited home-based care management for new patients.
This summary is intended for clinicians, billing professionals, and policy analysts seeking a clear, national-level understanding of HCPCS Level II code G0076, its intended use, and the topics to consider when evaluating coverage and operational implementation. Data not available in the input will be noted in detailed sections.
Billing Code Overview
HCPCS Level II code G0076 represents a brief (20 minutes) care management home visit for a new patient. This service is intended for use only within a Medicare-approved CMMI model and must be furnished in a patient's home, domiciliary, rest home, assisted living, or nursing facility. The service type is care management home visit for a new patient. The typical site of service is the beneficiary's residence or residential care setting as listed above.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A home-based care management initial visit for a new Medicare beneficiary enrolled in a CMS Innovation (CMMI) model. The visit is scheduled for approximately 20 minutes at the patient’s residence in an assisted living facility. The patient is a 78-year-old with multiple chronic conditions, including congestive heart failure, type 2 diabetes mellitus, and mild cognitive impairment, recently discharged from the hospital. A care manager (usually a nurse or social worker) conducts the visit to perform a focused assessment: reviewing current medications, verifying medication adherence, assessing recent symptoms (weight gain, dyspnea, dizziness), confirming home safety, evaluating social supports, and initiating a personalized care plan and referrals (e.g., primary care follow-up, home health, durable medical equipment). Documentation includes visit time (20 minutes), location (home/assisted living), reason for visit, findings, updated problem list, medication reconciliation, care plan goals, and any patient/caregiver education provided. This code is reported only for new patients enrolled in the Medicare-approved CMMI model and must be furnished in a beneficiary’s home, domiciliary, rest home, assisted living, or nursing facility.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Anesthesia standard primary | Not applicable to this service; included in list but rarely used for home care management visits. |