G4030 Pulmonology MIPS - Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G4030: Pulmonology MIPS Specialty Set

HCPCS Level II code G4030 designates the Pulmonology MIPS specialty set, a quality-reporting identifier used by pulmonology clinicians participating in Medicare’s Merit-based Incentive Payment System. Nationally, such codes matter because they standardize quality measurement and reporting across pulmonary care settings, influencing performance reporting and program participation at scale.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what G4030 represents, the clinical and reporting context for pulmonology quality measures, and which payers are relevant in national discussions. The publication also covers benchmark and policy context: expected use cases for MIPS specialty sets, where this code is typically applied (outpatient pulmonology and ambulatory clinics), and how G4030 fits within broader quality reporting workflows.

This summary provides a concise reference for clinicians, administrators, and policy analysts seeking to understand the role of G4030 in pulmonology quality reporting, what payers to consider in national analyses, and which operational settings most commonly deploy the code. Data not available in the input is identified where relevant.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG4030HCPCS Level IIPulmonologyMIPSQuality ReportingOutpatient CareAmbulatory ClinicsHealthcare BillingPerformance Measures

Billing Code Overview

HCPCS Level II code G4030 represents the Pulmonology MIPS specialty set. This code is used for reporting and tracking quality measures tied to the Medicare Merit-based Incentive Payment System (MIPS) for clinicians and groups delivering pulmonology services.

Service Type: Pulmonology quality reporting / MIPS specialty measures

Typical Site of Service: Outpatient pulmonology clinics and ambulatory settings where pulmonary specialists provide care and report MIPS quality measures

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 62-year-old with a history of chronic obstructive pulmonary disease (COPD) and recurrent exacerbations referred to a pulmonology clinic for quality reporting under the Pulmonology MIPS specialty set (G4030). The patient presents for a scheduled follow-up visit to assess symptom control, inhaler technique, oxygen requirements, and adherence to guideline-based care. The clinical workflow includes nurse intake with vitals and pulse oximetry, review of recent hospitalizations and medication changes, focused pulmonary history and exam by the pulmonologist, spirometry or interpretation review if available, medication reconciliation, and development of a management plan documented to satisfy MIPS measures (e.g., COPD exacerbation counseling, influenza vaccination assessment, smoking cessation counseling). Ancillary activities may include ordering chest imaging, laboratory tests, home oxygen evaluation, or referral to pulmonary rehabilitation. Visit documentation captures decision-making, time spent, and any required counseling or shared decision-making elements for reporting and billing purposes.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work or complexity substantially exceeds usual for the service and documentation supports additional work for the visit or procedure.

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HCPCS-G8734-ELDER-MALTREATMENT-SCREEN-NEGATIVE-NO-FOLLOW-UP

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HCPCS-G9809-HOSPICE-SERVICES-UTILIZATION

HCPCS G9809: Patients Using Hospice Services During Measurement Period

HCPCS-G9916-FUNCTIONAL-STATUS-ASSESSMENT-ONCE-IN-12-MONTHS

HCPCS G9916: Functional Status Assessment Performed Once in 12 Months

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Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207RP1000X`	Pulmonology	Specialists who typically report pulmonology MIPS measures and manage complex pulmonary disease.
`207RH0000X`	Critical Care Medicine	Critical care pulmonologists who may manage hospitalized or mechanically ventilated patients contributing to quality measures.
`207RI0200X`	Sleep Medicine	Pulmonologists with sleep certification who manage comorbid sleep-disordered breathing relevant to pulmonary quality reporting.
`207L00000X`	Internal Medicine	General internists who provide longitudinal COPD/asthma management and report primary care–based quality metrics.
`261QM0201X`	Registered Respiratory Therapist (RT)	Allied provider involved in spirometry, pulmonary function testing, and inhaler technique instruction.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J44.9`	Chronic obstructive pulmonary disease, unspecified	Common indication for pulmonology follow-up and inclusion in pulmonology MIPS reporting.
`J45.909`	Unspecified asthma, uncomplicated	Asthma management is frequently tracked in pulmonology quality measures.
`J96.00`	Acute respiratory failure, unspecified whether with hypoxia or hypercapnia	Relevant when patients have recent exacerbations requiring intensified pulmonary care.
`R06.02`	Shortness of breath	Symptom commonly prompting pulmonology evaluation captured in visit documentation.
`Z87.891`	Personal history of nicotine dependence	Smoking history relevant to COPD/asthma management and quality counseling measures.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`94010`	Measurement of spirometry, total and timed vital capacity	Performed during or around the pulmonology visit to assess lung function and guide management.
`94060`	Bronchodilator responsiveness, spirometry as in `94010` pre- and post-bronchodilator	Used when assessing reversibility in obstructive lung disease during the pulmonary evaluation.
`94640`	Pressurized or non-pressurized inhalation treatment for acute airway obstruction; administration of nebulized medication	May be provided in-clinic for acute symptom relief during the visit.
`94002`	Bronchospasm evaluation; spirometry with maximal voluntary ventilation when performed	Associated specialized pulmonary testing performed by the pulmonology team as part of diagnostic workup.
`94620`	Pulmonary diagnostic testing; inhalation treatment for acute airway obstruction by metered dose inhaler, with spacer	Used for inhaler training and administration when assessing technique during the consult.

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