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    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g0080-extensive-care-management-home-visit-new-patient
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    HCPCS G0080: Extensive Care Management Home Visit for New Patient

    HCPCS Level II code G0080 describes an extensive care management home visit of approximately 75 minutes for a new patient within a Medicare-approved CMMI model, classified as care management home visit services delivered in the beneficiary's home, domiciliary, rest home, assisted living, or nursing facility and intended to support comprehensive care coordination and management needs for patients requiring prolonged in-person assessment and planning.

    For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is a Medicare beneficiary newly enrolled in a Medicare-approved CMMI (Center for Medicare and Medicaid Innovation) care management model who requires an initial comprehensive home-based care management visit. The patient is homebound due to advanced congestive heart failure, multiple chronic conditions, or frailty and resides in a private residence, assisted living, domiciliary, rest home, or nursing facility. A multidisciplinary clinician (commonly a nurse practitioner or physician) conducts a 75-minute face-to-face visit within the patient’s home setting to establish the care plan, perform medication reconciliation, evaluate functional status, assess social determinants of health, coordinate community and home health services, and document goals of care. The clinical workflow includes pre-visit chart review and coordination with the care team, an in-home assessment lasting approximately 75 minutes focused on comprehensive medical, behavioral, and social needs, development and documentation of a care management plan, communication of the plan to the patient and caregivers, initiation of referrals (home health, PT/OT, durable medical equipment), and follow-up scheduling. Documentation must specify time spent, location of service, that the patient is new to the program, elements of the comprehensive assessment and care plan, and any coordination activities required by the CMMI model. Billing uses G0080 for the extensive, 75-minute initial home visit only within a Medicare-approved CMMI model and only when services are furnished in the beneficiary’s home, domiciliary, rest home, assisted living, or nursing facility.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99341Home visit for evaluation and management of a new patient, typically 20 minutesMay be used for shorter initial home visit E/M encounters when G0080 is not applicable; usually replaced by G0080 within the Medicare CMMI model for extensive 75-minute visits.
    99347Home visit for evaluation and management of an established patient, typically 15 minutesMay follow initial comprehensive visits for routine monitoring; used for shorter established-patient home visits outside the CMMI G0080 context.
    99490Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health professional, per calendar monthOften performed as ongoing non-face-to-face care management complementing the initial face-to-face G0080 visit for continuous care coordination.
    99487Complex chronic care management services, first hour of clinical staff time directed by a physician or other qualified health professional, per calendar monthUsed when patients require more complex monthly non-face-to-face care management that complements the comprehensive initial face-to-face visit.
    99510Home visit for inspection and assessment of abuse/neglect of a child or vulnerable adultMay be used if the comprehensive home assessment identifies suspected elder abuse or neglect and a separate documented visit is required for investigation.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    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…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    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
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    163WU0100XUrology Registered NurseNursing Service Providers · Registered Nurse
    246ZB0500XBiochemistTechnologists, Technicians & Other Technical Service Providers · Specialist/Technologist, Other
    3336S0011XSpecialty PharmacyA pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses t…
    163WR0006XRegistered Nurse First AssistantA perioperative registered nurse who works in collaboration with the surgeon and other health care team members to achieve optimal outcomes. The RNFA…

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    7 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01
    Celiac Disease TestingOscar Health2026-10-01

    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

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    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.
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