Summary & Overview
HCPCS G8495: Completion of CKD Quality Measures Bundle
HCPCS Level II code G8495 documents that all required quality actions for the chronic kidney disease (CKD) measures group have been completed for a patient. As a quality-reporting code, G8495 is used to indicate adherence to CKD care measures and supports performance tracking, value-based payment programs, and quality reporting at a national level. The code matters because CKD affects a large and growing patient population, and standardized documentation of measure completion enables payers and providers to monitor care quality and meet reporting requirements.
Key payers included in the discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what G8495 represents clinically and operationally, the typical service setting where it is captured, and how it functions as a quality-reporting marker. The publication outlines common benchmarking topics and policy considerations related to CKD quality measurement, describes the clinical context for CKD measure bundles, and identifies where additional data would be required for payer-specific billing, modifier use, associated taxonomies, and linked diagnosis codes. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G8495 indicates that all quality actions for the applicable measures in the chronic kidney disease (CKD) measures group have been performed for this patient. This code documents completion of the CKD measures bundle for an individual patient.
Service type: Quality measure bundle documentation and reporting
Typical site of service: Outpatient clinic, nephrology practice, primary care setting, or any ambulatory care location where CKD quality measures are tracked and reported
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with established chronic kidney disease (CKD) receiving longitudinal primary care or nephrology management. The visit occurs in an outpatient clinic, renal specialty clinic, or integrated care setting where the clinical team performs and documents all quality actions required by the CKD measures group for the patient’s reporting period. Actions include assessment of estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (UACR), blood pressure measurement and control, medication reconciliation (including ACE inhibitor/ARB and sodium-glucose cotransporter-2 inhibitor consideration when indicated), CKD staging documentation, patient education on kidney disease and nutrition, and referral to nephrology or vascular access planning if appropriate. Documentation workflows typically involve review of recent laboratory results, medication list reconciliation, vital signs capture, counseling notes, and completion of any electronic quality measure checklists or flowsheets that confirm each required element. The care team members include the ordering clinician (primary care physician or nephrologist), nursing staff for vitals and education, and medical assistants or care coordinators for follow-up scheduling and referrals. The performed and documented completion of all required CKD measure actions is represented by billing code G8495 to indicate that all applicable quality actions for the CKD measures group have been performed for that patient.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 |