HCPCS G4024: Pediatrics MIPS Specialty Set - OpenPayer

Summary & Overview

HCPCS G4024: Pediatrics MIPS Specialty Set

HCPCS Level II code G4024 identifies the Pediatrics MIPS specialty set, a bundle of quality measures used for pediatric clinicians participating in federal value-based reporting programs. Nationally, specialty measure sets like this inform quality reporting, performance benchmarking, and program compliance across pediatric primary and ambulatory care. Adoption of standardized pediatric measure sets influences practice workflows, electronic health record configuration, and payer-provider reporting requirements.

Key payers referenced in national discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s purpose, which payer programs commonly engage with pediatric MIPS measures, and what to expect in terms of measure-set relevance for pediatric outpatient care. The publication also outlines available benchmarks, recent policy updates affecting MIPS participation, and the clinical context for pediatric quality measurement. Where specific data elements are not provided in the source input, the document notes "Data not available in the input."

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG4024HCPCS Level IIPediatricsMIPSQuality MeasuresOutpatient PediatricsValue-Based CareMeasure Set

Billing Code Overview

HCPCS Level II code G4024 represents the Pediatrics MIPS specialty set. This code designates a specialty-level quality measure set intended for pediatric practices participating in the Merit-based Incentive Payment System (MIPS).

Service type: Quality measurement and reporting for pediatric clinical practice
Typical site of service: Outpatient pediatric clinics and ambulatory care settings

Clinical & Coding Specifications

Clinical Context

A pediatric primary care practice participates in the Merit-based Incentive Payment System (MIPS) specialty set for Pediatrics to report quality and performance measures. Typical workflow: a pediatrician or pediatric nurse practitioner documents preventive visits, chronic condition management (for asthma, ADHD, obesity), immunization status, developmental screenings, and care coordination activities in the electronic health record. Staff extract measure data for MIPS reporting, confirm patient demographics and payer enrollment, and submit the G4024 specialty set data for the reporting period. Typical site of service is an outpatient pediatric clinic or community health center providing well-child visits, sick visits, and chronic care management for patients from neonates through adolescents. A common patient scenario: an 8-year-old with persistent asthma attends a scheduled follow-up for medication adjustment and inhaler technique review; the clinician completes required preventive care measures, documents vaccinations and asthma control assessment, and the practice includes the encounter in the Pediatrics MIPS Specialty Set submission.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when services require substantially greater work than typical and documentation supports increased complexity.

HCPCS G9607: Documented Reasons for Not Performing Intraoperative Cystoscopy

HCPCS-G9604-PATIENT-SURVEY-RESULTS-NOT-AVAILABLE

HCPCS G9604: Patient Survey Results Not Available

HCPCS-G8536-ELDER-MALTREATMENT-SCREENING-NOT-DOCUMENTED

HCPCS G8536: No Documentation of Elder Maltreatment Screen, Reason Not Given

HCPCS-G9519-POSTOPERATIVE-REFRACTIVE-OUTCOME-WITHIN-90-DAYS

HCPCS G9519: Postoperative Refractive Outcome Within 90 Days

HCPCS-G8697-ANTITHROMBOTIC-THERAPY-NOT-PRESCRIBED-DOCUMENTED-REASONS

HCPCS G8697: Antithrombotic Therapy Not Prescribed for Documented Reasons

HCPCS-G9164-SPOKEN-LANGUAGE-EXPRESSION-DISCHARGE-STATUS

HCPCS G9164: Spoken Language Expression Functional Limitation at Discharge

HCPCS-G0534-OPIOID-TREATMENT-PROGRAM-CARE-COORDINATION-REFERRAL

HCPCS G0534: Care Coordination and Referral Services for Opioid Treatment

HCPCS-G0427-TELEHEALTH-CONSULTATION-EMERGENCY-INPATIENT-70MIN

HCPCS G0427: Telehealth Consultation, ED or Initial Inpatient ≥70 Minutes

HCPCS-G0137-INTENSIVE-OUTPATIENT-MENTAL-HEALTH-WEEKLY-BUNDLE

HCPCS G0137: Intensive Outpatient Behavioral Health Weekly Bundle

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

HCPCS G0179: Practitioner Re-certification for Medicare Home Health

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`208000000X`	Pediatrics	Primary specialty responsible for pediatric preventive and chronic care for this set.
`208000000X.PEDI`	Pediatric Primary Care (clinician)	Clinicians delivering MIPS pediatric measures, including well-child and chronic care.
`363L00000X`	Nurse Practitioner	Pediatric NPs who provide primary care, vaccine administration, and documentation for MIPS.
`193200000X`	Physician Assistant	PAs who assist in pediatric outpatient care and relevant measure documentation.
`207Q00000X`	Family Medicine	Family physicians who provide pediatric care and may report on pediatric MIPS measures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J45.909`	Unspecified asthma, uncomplicated	Asthma is a common chronic pediatric condition included in Pediatrics MIPS measures for control assessment and medication management.
`F90.9`	Attention-deficit hyperactivity disorder, unspecified	ADHD management and medication safety are tracked in pediatric quality measures.
`E66.9`	Obesity, unspecified	Pediatric obesity screening and counseling are components of preventive care measures.
`Z00.121`	Encounter for routine child health examination with abnormal findings	Well-child visits with findings drive preventive interventions and measure capture.
`Z23`	Encounter for immunization	Immunization status is a core component of pediatric quality reporting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99381`	Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance and risk factor reduction intervention(s), and the ordering of appropriate immunizations, laboratory/diagnostic procedures; infant (new patient under 1 year)	Used for initial well-child visits that feed preventive care measures in the Pediatrics MIPS set.
`99382`	Initial comprehensive preventive medicine evaluation and management; early childhood (1–4 years)	Used for early childhood well visits documented for MIPS quality measures.
`99383`	Initial comprehensive preventive medicine evaluation and management; late childhood (5–11 years)	Used for school-age well-child visits contributing to MIPS reporting.
`99394`	Periodic comprehensive preventive medicine reevaluation and management; adolescent (12–17 years)	Used for adolescent well visits included in Pediatrics MIPS measures such as immunization status and screening.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Used when counseling is provided to caregiver or adolescent and documented for quality measures.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Used when ongoing care coordination for chronic pediatric conditions (e.g., asthma) is provided and documented for MIPS care coordination measures.

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