HCPCS G0080: Extensive 75-Minute Care Management Home Visit for New Patient - OpenPayer

Summary & Overview

HCPCS G0080: Extensive 75-Minute Care Management Home Visit for New Patient

HCPCS Level II code G0080 represents an intensive, time-based care management home visit of approximately 75 minutes for a new patient and is limited to use within Medicare-approved CMMI models. Nationally, this code matters because it captures extended, in-home care management encounters aimed at beneficiaries with complex needs, and it is tied to demonstration models that influence care coordination practices for high-need populations. Key payers in the national context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical intent of the code, typical service settings, and the payer landscape addressed in this analysis. The publication provides benchmarks where available, summarizes relevant policy or program contexts affecting use of G0080, and outlines clinical scenarios consistent with an extensive in-home care management visit. Data not available in the input are noted where applicable. This summary is intended for a national audience of billing managers, policy analysts, and care program administrators seeking clarity on the purpose and operational context of HCPCS Level II code G0080.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0080HCPCS Level IIhome visitcare managementCMMIin-home caretime-based visitnew patient

Billing Code Overview

HCPCS Level II code G0080 denotes an extensive (75 minutes) care management home visit for a new patient, authorized for use only within a Medicare-approved Center for Medicare & Medicaid Innovation (CMMI) model. The code describes a time-based, intensive care management encounter delivered face-to-face.

Service type: Extensive care management home visit (75 minutes)
Typical site of service: Patient's home, domiciliary, rest home, assisted living, or nursing facility

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

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.

Coding Specifications

Modifier	Description	When to Use

HCPCS G9219: PCP Prophylaxis Not Prescribed for Medical Reason

HCPCS-G9102-GASTRIC-ADENOCARCINOMA-DISEASE-STATUS-ASSESSMENT

HCPCS G9102: Gastric Adenocarcinoma Disease Status Assessment

HCPCS-G0380-LEVEL-1-HOSPITAL-EMERGENCY-DEPARTMENT-VISIT-TYPE-B

HCPCS G0380: Level 1 Hospital Emergency Department Visit, Type B

HCPCS-G0078-MODERATE-CARE-MANAGEMENT-HOME-VISIT-NEW-PATIENT

HCPCS G0078: Moderate Care Management Home Visit for New Patient

HCPCS-G8942-FUNCTIONAL-OUTCOME-ASSESSMENT-CARE-PLAN

HCPCS G8942: Functional Outcome Assessment with Timely Care Plan

HCPCS-G9013-ESRD-BASIC-BUNDLE-LEVEL-I

HCPCS G9013: ESRD Demo Basic Bundle Level I

HCPCS-G9649-PSORIASIS-ASSESSMENT-TOOL-DOCUMENTATION

HCPCS G9649: Psoriasis Assessment Tool Documentation

HCPCS-G9887-BEHAVIORAL-COUNSELING-DIABETES-PREVENTION-DISTANCE-LEARNING-60-MINUTES

HCPCS G9887: Behavioral Counseling for Diabetes Prevention, Distance Learning, 60 Minutes

HCPCS-G8669-ELBOW-WRIST-HAND-FUNCTIONAL-STATUS-NOT-COMPLETED

HCPCS G8669: Elbow, Wrist or Hand Functional Status — Not Completed

HCPCS-G2182-FIRST-TIME-BIOLOGIC-THERAPY-INITIATION

HCPCS G2182: First-Time Biologic or Immune Response Modifier Therapy Initiation

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
363L00000X	Nurse Practitioner	NPs commonly perform home-based comprehensive care management visits under CMMI models.
207Q00000X	Family Medicine	Family physicians often provide initial home-based care management assessments and care planning.
207R00000X	Internal Medicine	Internists provide complex chronic disease management during home visits.
163W00000X	Geriatric Medicine	Geriatricians frequently perform comprehensive home assessments for frail older adults.
263QM0800X	Clinical Nurse Specialist	CNS clinicians perform advanced practice nursing assessments and care coordination in home settings.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99341`	Home visit for evaluation and management of a new patient, typically 20 minutes	May 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.
`99347`	Home visit for evaluation and management of an established patient, typically 15 minutes	May follow initial comprehensive visits for routine monitoring; used for shorter established-patient home visits outside the CMMI `G0080` context.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health professional, per calendar month	Often performed as ongoing non-face-to-face care management complementing the initial face-to-face `G0080` visit for continuous care coordination.
`99487`	Complex chronic care management services, first hour of clinical staff time directed by a physician or other qualified health professional, per calendar month	Used when patients require more complex monthly non-face-to-face care management that complements the comprehensive initial face-to-face visit.
`99510`	Home visit for inspection and assessment of abuse/neglect of a child or vulnerable adult	May be used if the comprehensive home assessment identifies suspected elder abuse or neglect and a separate documented visit is required for investigation.

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