Summary & Overview
HCPCS G0087: Comprehensive Care Management Home Care Plan Oversight
HCPCS Level II code G0087 represents a comprehensive, 60-minute care management home care plan oversight service limited to Medicare-approved CMMI models. The code covers time-intensive coordination and oversight activities performed in a beneficiary’s residence or long-term care setting — including private homes, domiciliary arrangements, rest homes, assisted living facilities, and nursing facilities. Nationally, this code matters because it targets complex care coordination needs among high-risk populations and aligns with value-based care initiatives under Medicare innovation models.
Key payers addressed in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context and service setting, documentation and billing considerations tied to the code’s defined use in Medicare CMMI models, and a summary of common modifiers associated with similar care management services (input lists provided). The report also outlines where data were available and notes items omitted due to lack of input. The intent is to clarify the clinical purpose, expected site of service, and payer landscape relevant to G0087 so that policy, billing, and clinical teams can reference the code consistently within national care-management and Medicare innovation contexts.
Billing Code Overview
HCPCS Level II code G0087 describes Comprehensive (60 minutes) care management home care plan oversight for use only in a Medicare-approved CMMI model. The service covers management and oversight activities provided for approximately 60 minutes and is intended to coordinate and oversee comprehensive care plans for beneficiaries enrolled in the designated model.
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Service type: Care management and care plan oversight
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Typical site of service: Beneficiary's home, domiciliary, rest home, assisted living, or nursing facility
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 78-year-old Medicare beneficiary enrolled in a CMS Innovation Center model receives comprehensive care management home care plan oversight billed with G0087. The patient has multiple chronic conditions including heart failure, chronic obstructive pulmonary disease, and diabetes, requires frequent medication reconciliation, and lives in an assisted living facility. A nurse care manager (or physician coordinator) conducts a 60-minute in-home visit to review the overall care plan, coordinate durable medical equipment and home health services, reconcile medications with the primary care physician, update advance care planning documents, and communicate needed changes to the interdisciplinary team. Documentation includes start and stop times, detailed plan-of-care updates, coordination activities (calls, orders, referrals), patient or caregiver education provided, and any barriers to care. Services are only furnished within the beneficiary’s home, domiciliary, rest home, assisted living, or nursing facility and must align with the Medicare-approved CMMI model requirements for comprehensive home care plan oversight.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Physician/Practitioner billing for services | Use when the service is billed by the primary treating physician or practitioner who provided oversight. |