Summary & Overview
HCPCS G8491: Intent to Report HIV/AIDS Measures
HCPCS Level II code G8491 denotes an intent to report the HIV/AIDS measures group for clinical quality reporting. Nationally, quality-reporting codes like G8491 matter because they standardize how providers communicate participation in measure sets tied to public health surveillance, value-based programs, and payer reporting requirements. Use of such intent codes can affect measure submission workflows and downstream quality analytics.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what G8491 represents, the service context for its use, and how it functions within quality reporting programs. The publication summarizes benchmark implications, common reporting pathways, and policy considerations relevant to national payer programs and public health reporting.
This summary covers: the clinical and administrative purpose of the code, expected service settings, and an outline of what stakeholders should expect when encountering G8491 in claims or quality submissions. Data not provided in the source is noted explicitly as unavailable.
Billing Code Overview
HCPCS Level II code G8491 indicates an intent to report the HIV/AIDS measures group. This code is used to signify that the provider or reporting entity intends to submit or has submitted clinical quality measure data related to HIV and AIDS care.
Service Type: Quality reporting / clinical measures reporting
Typical Site of Service: Outpatient clinic or ambulatory care settings where quality reporting and measure capture occur
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult living with HIV who presents for quality reporting and performance measurement documentation during a primary care or infectious disease clinic visit. The clinician documents participation in the HIV/AIDS measures group to indicate intent to report performance measures related to antiretroviral therapy adherence, viral load suppression, retention in care, and screening for comorbid conditions.
The clinical workflow begins with registration and problem list review, confirmation of HIV diagnosis and current antiretroviral regimen, and collection of lab orders such as HIV RNA (viral load) and CD4 count. The clinician documents counseling on medication adherence, reviews recent lab results, and orders necessary screenings (e.g., hepatitis B/C, sexually transmitted infections). The clinic’s quality or billing staff then links the visit to the HIV/AIDS measures group using billing code G8491 to indicate the intent to report the measure set for payer quality programs. Typical follow-up includes scheduling routine monitoring visits, arranging case management if adherence issues are identified, and ensuring data capture for performance reporting to payors and registries.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a significant E/M visit is provided on the same day as procedures or services related to HIV care. |