Summary & Overview

HCPCS G8494: Completion of Diabetes Mellitus Quality Actions

HCPCS Level II code G8494 denotes that all specified quality actions for the diabetes mellitus (DM) measures group have been completed for a patient. The code is a documentation marker used in ambulatory and outpatient settings to indicate fulfillment of diabetes quality measures, which supports performance reporting and quality programs at a national level. It matters because accurate use of this code affects quality measurement, reporting compliance, and value-based payment programs that rely on documented completion of measure sets.

Key payers relevant to national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical and administrative purpose, typical sites of service, and how it fits into quality reporting workflows. The publication covers common use cases, implications for quality reporting and claims documentation, and where this code sits within diabetes measure reporting frameworks. Additionally, readers will find benchmark context and recent policy considerations affecting diabetes quality measure documentation. Data not available in the input are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG8494HCPCS Level IIdiabetes quality measuresquality reportingoutpatient careperformance measurementvalue-based careambulatory care

Billing Code Overview

HCPCS Level II code G8494 indicates that all quality actions for the applicable measures in the diabetes mellitus (dm) measures group have been performed for this patient. This code is used to document completion of required quality actions tied to diabetes care measures.

Service Type: Quality measurement / performance reporting

Typical Site of Service: Outpatient clinic or ambulatory care setting where diabetes quality measures are assessed and documented

Data not available in the input for payers, common modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A primary care team documents and completes all required diabetes mellitus quality measures during a chronic care visit for a 58-year-old patient with type 2 diabetes. The patient presents for a scheduled chronic care appointment with their primary care clinician and care coordinator. Pre-visit planning identifies outstanding measure elements: HbA1c testing within the measurement period, blood pressure measurement and control, statin therapy assessment, influenza vaccine reconciliation, tobacco screening and cessation counseling status, nephropathy screening (urine albumin), and diabetic retinal eye exam referral status. During the visit the clinician reviews recent laboratory results, documents an HbA1c value, measures and records blood pressure, confirms current medications including statin use, orders or documents urine microalbumin, verifies retinal eye exam completion or places a referral, updates immunization status, and records tobacco use status. A care coordinator confirms that all actions required by the diabetes mellitus measures group have been performed, and the practice submits the quality action using billing code G8494 to indicate all applicable diabetes measure components were completed for the reporting period.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service	Use when the clinician provides a distinct E/M visit in addition to completing the diabetes quality actions billed with `G8494`.
`59`	Distinct procedural service	Use when distinguishing separate, unrelated procedures or services provided the same day from the diabetes quality measure actions.
`24`	Unrelated evaluation and management service by the same physician during a post-operative period	Use if the diabetes quality action is reported during a global postoperative period and an unrelated E/M is furnished.
`76`	Repeat procedure or service by same physician	Use if a repeated diabetes measure action (e.g., repeat HbA1c measurement) is performed by the same provider on the same day.
`77`	Repeat procedure by another physician	Use if a repeated diabetes measure action is performed by a different physician.
`RT`	Right side	Rarely applicable; use when laterality is required to distinguish services associated with a unilateral intervention related to diabetes (for example, foot exam documentation tied to a side-specific procedure).
`LT`	Left side	As above for left-sided services when laterality is applicable.
`GA`	Waiver of liability statement on file; no timely filing penalty	Use when an advance beneficiary notice is on file and needed for payor requirements related to diabetes services.
`GP`	Services rendered under an outpatient physical therapy plan of care	Use when diabetes-related education or exercise therapy is billed under therapy plan of care related to diabetes management.
`GQ`	Telehealth via asynchronous telecommunications system	Use when components of the diabetes measure set are completed via asynchronous telehealth methods applicable to this service.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when the clinician completes diabetes measure elements during a real-time telemedicine visit.
`XE`	Separate encounter, a service that is distinct because it occurred during a separate encounter	Use to indicate the diabetes quality actions were performed during a separate encounter from other services.
`XS`	Separate practitioner, a service that is distinct because it was performed by a different practitioner	Use when different practitioners performed distinct components of the diabetes measure set.
`XP`	Separate practitioner, distinct location	Use when elements of diabetes quality actions were performed at a different site of service than other billed services.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary clinicians who most commonly document and complete diabetes quality measures.
`207R00000X`	Internal Medicine	General internists providing diabetes chronic disease management and quality reporting.
`208D00000X`	Endocrinology	Specialists managing complex diabetes cases and confirming measure completion.
`363L00000X`	Certified Diabetes Educator	Professionals who provide diabetes education and document self-management support measures.
`341600000X`	Registered Dietitian/Nutritionist	Provides medical nutrition therapy and documents nutrition-related measure components.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.9`	Type 2 diabetes mellitus without complications	Represents the common patient population for diabetes quality measure reporting linked to `G8494`.
`E11.65`	Type 2 diabetes mellitus with hyperglycemia	Relevant when recent HbA1c or management changes are documented as part of the measure set.
`E11.21`	Type 2 diabetes mellitus with diabetic nephropathy	Indicates kidney involvement; nephropathy screening (urine albumin) is a measure component documented when reporting `G8494`.
`E11.51`	Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene	Relevant to foot exam documentation and vascular complication surveillance in diabetes quality measures.
`E11.41`	Type 2 diabetes mellitus with diabetic neuropathy, unspecified	Neuropathy assessment and foot exam documentation are part of comprehensive diabetes quality actions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`83036`	Hemoglobin; glycosylated (A1c)	Performed or reviewed as a core diabetes quality measure component to document glycemic control prior to reporting `G8494`.
`81003`	Urinalysis, by dip stick or tablet reagent; non-automated, without microscopy	Used when screening for glycosuria or initial urine testing; may accompany nephropathy screening documented for diabetes measures.
`82043`	Albumin; urine (e.g., microalbumin), quantitative	Performed to assess diabetic nephropathy as part of the diabetes quality measure set.
`36415`	Collection of venous blood by venipuncture	Commonly performed to obtain blood for HbA1c and other labs used to satisfy diabetes measure requirements.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Typical E/M used when clinicians address multiple diabetes control issues and complete measure documentation alongside `G8494`.