G2115 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G2115: Frailty with Dispensed Dementia Medication, Ages 66–80

HCPCS Level II code G2115 denotes patients aged 66–80 with at least one encounter for frailty during the measurement period and a dispensed dementia medication during the measurement period or the prior year. The code supports identification and tracking of a clinically vulnerable older population at the intersection of frailty and dementia treatment. Nationally, this code matters for population health monitoring, quality measures, and care coordination for older adults with cognitive impairment and frailty, given the potential implications for medication safety, care transitions, and advanced care planning.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks and national-level context for the use of G2115, summaries of payer coverage considerations, and clinical context related to frailty and dementia medication dispensing. The publication also outlines policy updates and coding guidance that affect how this population is identified in claims data, and it highlights implications for outpatient and ambulatory care workflows. Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, related codes, and service line are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG2115HCPCS Level IIfrailtydementia medicationgeriatricspopulation healthmedication safetyoutpatient

Billing Code Overview

HCPCS Level II code G2115 identifies patients aged 66 to 80 years who have at least one claim or encounter for frailty during the measurement period and who have a dispensed medication for dementia during the measurement period or in the year prior. The service type reflected by this code is clinical population identification / chronic condition medication reconciliation, focused on older adults with coexisting frailty and dementia medication use. The typical site of service is ambulatory care or outpatient clinic settings where encounters and medication dispensing are recorded, including primary care clinics, geriatrics clinics, memory disorder centers, and outpatient pharmacy records.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an older adult between 66 and 80 years of age with documented frailty and a recent or ongoing dispensed medication for dementia (for example, donepezil, rivastigmine, galantamine, or memantine) during the measurement period or in the year prior. The clinical workflow begins in primary care, geriatrics, or neurology where the patient presents for routine follow-up or care coordination. Frailty identification may occur through frailty screening (clinical frailty scale, gait speed, weight loss, exhaustion, or clinician documentation) recorded as a claim or encounter. Medication reconciliation confirms a dispensed dementia medication within the specified timeframe. The clinician documents frailty and reviews the dementia medication list in the electronic health record, ensuring pharmacy fill history supports the claim. Coding staff then assign the HCPCS Level II code G2115 on the claim to indicate the patient meets the measure: age 66–80, a frailty encounter, and a dispensed dementia medication during the measurement period or prior year. Typical sites of service include primary care clinics, geriatric clinics, neurology outpatient practices, home health visits, and long-term care or assisted living facility encounters where medication administration and frailty assessments are documented.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

HCPCS G0117: Glaucoma Screening for High-Risk Patients

HCPCS-G9151-MAPCP-DEMONSTRATION-STATE-PROVIDED-SERVICES

HCPCS G9151: MAPCP Demonstration - State Provided Services

HCPCS-G9305-ANASTOMOSIS-NO-INTERVENTION-FOR-LEAK

HCPCS G9305: No Intervention for Anastomotic Leak

HCPCS-G9497-PREOP-SMOKING-ABSTINENCE-INSTRUCTION

HCPCS G9497: Preoperative Instruction to Abstain from Smoking

HCPCS-G8634-NOT-ELIGIBLE-FOR-PHARMACOLOGIC-OSTEOPOROSIS-THERAPY

HCPCS G8634: Clinician-documented Not Eligible for Osteoporosis Pharmacologic Therapy

HCPCS-G0179-HOME-HEALTH-RECERTIFICATION-PRACTITIONER-REVIEW

HCPCS G0179: Practitioner Re-certification for Medicare Home Health

HCPCS-G8572-NO-DEEP-STERNAL-WOUND-INFECTION-MEDIASTINITIS

HCPCS G8572: No Deep Sternal Wound Infection/Mediastinitis

HCPCS-G9400-DOCUMENTATION-TREATMENT-DISCUSSION-OMISSION-REASONS

HCPCS G9400: Documentation of Reasons for Not Discussing Treatment Options

HCPCS-G2136-POSTOPERATIVE-BACK-PAIN-OUTCOME-VAS-NUMERIC-SCALE

HCPCS G2136: Postoperative Back Pain Outcome by VAS or Numeric Scale

HCPCS-G9912-HBV-ASSESSMENT-BEFORE-ANTI-TNF-THERAPY

HCPCS G9912: Hepatitis B Assessment and Interpretation Before Anti-TNF Therapy

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly identify frailty and manage dementia medications.
`207R00000X`	Internal Medicine	Internists frequently assess frailty and coordinate dementia medication management.
`2084P0800X`	Geriatric Medicine	Geriatricians regularly perform frailty assessments and manage dementia pharmacotherapy.
`2084N0400X`	Neurology	Neurologists diagnose and treat dementia and document related medication dispenses.
`363L00000X`	Nurse Practitioner	Advanced practice clinicians frequently perform assessments and medication reconciliation in outpatient and long-term care settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R54`	Age-related physical debility	Captures clinical frailty or decline in older adults relevant to `G2115`.
`R53.83`	Other fatigue	Symptoms such as chronic fatigue can be components of frailty assessments documented for `G2115`.
`M62.84`	Muscle weakness (generalized)	Objective weakness contributes to frailty identification in the target population.
`F03.90`	Unspecified dementia, without behavioral disturbance	Represents dementia diagnoses for which dementia medications may be dispensed and thus meet `G2115` criteria.
`F03.91`	Unspecified dementia, with behavioral disturbance	Dementia with behavioral disturbance often requires medication management and is relevant to the measure.
`G31.84`	Mild cognitive impairment, so stated	Patients with mild cognitive impairment may be on dementia medications and assessed for frailty.
`Z91.19`	Patient's noncompliance with other medical treatment and regimen	Relevant when medication fills or adherence influence documentation of a dispensed dementia medication.
`Z79.899`	Other long term (current) drug therapy	Used to indicate ongoing pharmacologic therapy, including chronic dementia medications documented for `G2115`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Commonly used for follow-up visits where frailty is assessed and dementia medication reconciliation is performed prior to assigning `G2115`.
`99304`	Nursing facility new patient assessment	Used when frailty and dementia medication dispensing are evaluated during a new nursing facility admission encounter.
`99307`	Nursing facility subsequent care, per day, for the evaluation and management of a patient	Used for ongoing documentation of frailty and dementia medication management in long-term care when `G2115` criteria are met.
`99483`	Assessment of and care planning for a patient with cognitive impairment, including caregiver history and medication reconciliation	Performed when a comprehensive cognitive assessment and care plan are developed; often associated with documentation supporting `G2115`.
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory), per standardized instrument	May be performed as part of a frailty or dementia evaluation to document functional or mood components relevant to the `G2115` measure.

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