Summary & Overview
HCPCS G2114: Frailty with Dispensed Dementia Medication (Ages 66–80)
HCPCS Level II code G2114 designates a quality-measure cohort: Medicare-aged adults 66–80 years with at least one documented encounter for frailty and a dispensed dementia medication during the measurement period or in the prior year. Nationally, this code matters because it supports identification of older patients with overlapping frailty and dementia treatment needs, informing care coordination, quality reporting, and risk stratification efforts across payers.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical criteria embedded in the code, typical sites of service where these records are captured, and the types of benchmarks and policy-relevant uses associated with the measure. The publication outlines how G2114 can be used in quality measurement, population health analytics, and pharmacy oversight, and it summarizes typical implementation considerations and reporting contexts.
This summary does not include state-specific guidance and is intended for a national audience. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code G2114 identifies patients aged 66–80 years who have at least one claim or encounter for frailty during the measurement period and who received a dispensed medication for dementia either during the measurement period or in the year prior.
Service type: Quality measurement / patient cohort identification — the code is used to flag clinical and pharmacy activity meeting the specified age, diagnosis, and medication-dispensing criteria.
Typical site of service: Outpatient and ambulatory care settings, including primary care clinics, specialty neurology or geriatrics clinics, and outpatient pharmacy dispensing events where documentation of frailty and dementia medication dispensing can be captured.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an established primary care patient aged 66–80 who has had at least one documented encounter for frailty (for example, unintentional weight loss, decreased grip strength, slow gait, low activity, or exhaustion) during the measurement period. During a routine visit or a medication reconciliation encounter, the clinician documents frailty and reviews the medication list, confirming a pharmacy-dispensed agent for dementia (such as donepezil, rivastigmine, galantamine, or memantine) either during the measurement period or in the prior year. The clinical workflow commonly includes: initial nurse intake with vitals and frailty screening, provider evaluation confirming frailty and dementia diagnosis or cognitive decline, reconciliation of medication list against pharmacy records or e-prescribing history to verify a dispensed dementia medication, documentation of the encounter and medication in the electronic health record, and coding of the encounter for quality measurement and billing purposes. Typical sites of service are outpatient primary care clinics, geriatric clinics, memory disorder clinics, and ambulatory care centers. Common care team members involved are primary care physicians, geriatricians, nurse practitioners, physician assistants, clinical pharmacists, and medical coders who ensure the frailty encounter and the dementia medication dispense are documented for reporting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when additional work or complexity beyond usual is documented for the encounter (e.g., extended cognitive and frailty assessment). |