Summary & Overview
HCPCS G1023: Persivia Clinical Decision Support for Imaging Appropriateness
HCPCS Level II code G1023 designates a clinical decision support mechanism provided by Persivia under the Medicare Appropriate Use Criteria program. This code identifies the provision of a software-enabled decision support tool that assists clinicians with imaging appropriateness at the point of care. Nationally, standardized reporting of such decision support services matters for program compliance, interoperability, and claims processing for imaging-related workflows.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code purpose, payer coverage considerations, and the clinical context in which the mechanism is used. The discussion highlights where the service is typically delivered (outpatient settings, physician offices, and hospital outpatient departments) and explains the role of the mechanism within imaging ordering pathways.
The publication provides benchmarks and policy-relevant context for payers and providers, summarizes known billing practice considerations, and notes gaps where additional data is required. Data not available in the input is identified explicitly in relevant sections.
Billing Code Overview
HCPCS Level II code G1023 describes a clinical decision support mechanism provided by Persivia as defined by the Medicare Appropriate Use Criteria program. The service represents the use of a software-based decision support tool to deliver appropriate use criteria guidance to clinicians during imaging decision-making.
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Service type: Clinical decision support service
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Typical site of service: Hospital outpatient departments, physician offices, and other outpatient settings where imaging decisions and ordering occur
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male with a history of coronary artery disease and new onset chest pain who presents to an outpatient cardiology clinic for evaluation. The clinician orders an electrocardiogram and considers advanced imaging or invasive coronary angiography. Before ordering a cardiac CT angiogram or nuclear stress test, the clinician uses the Persivia clinical decision support mechanism to query the Medicare Appropriate Use Criteria (AUC) program for imaging appropriateness. The clinician enters patient data (symptoms, prior testing, comorbidities, and current medications) into the electronic health record (EHR) module integrated with Persivia. The decision support returns an appropriateness score and documentation summary which is incorporated into the medical record and used to justify the imaging order under Medicare AUC requirements.
Typical workflow steps:
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The clinician identifies the need for advanced cardiovascular imaging.
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The clinician opens the EHR order entry and launches the Persivia module (clinical decision support mechanism
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Patient clinical variables and the intended imaging study are entered and the CDS tool returns an appropriateness determination.
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The clinician reviews the output, documents the AUC interaction in the chart, and proceeds with ordering the imaging study if appropriate.
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The Persivia system generates an electronic record or report that aligns with Medicare AUC reporting requirements and is stored in the patient record.