Summary & Overview
HCPCS G8500: Completion of HIV/AIDS Quality Measures
HCPCS Level II code G8500 denotes that all required quality actions for the HIV/AIDS measures group have been completed for a patient. As a quality-reporting marker rather than a direct clinical procedure, G8500 documents adherence to measure sets used in performance reporting and value-based programs. Nationally, such codes matter because they support quality measurement, pay-for-performance, and compliance with reporting requirements tied to HIV/AIDS care.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise context on the purpose and clinical setting for G8500, an outline of typical payer coverage considerations, and guidance on where this code fits within quality-reporting workflows. The publication highlights benchmarks and policy-relevant considerations tied to quality measure reporting, summarizes common sites of service where G8500 applies, and notes areas where input data are not available. This summary is intended for a national audience of health plan analysts, billing professionals, and clinical administrators who manage quality reporting and claims documentation for HIV/AIDS care.
Billing Code Overview
HCPCS Level II code G8500 indicates that all quality actions for the applicable measures in the HIV/AIDS measures group have been performed for this patient. This reflects completion of the set of documented quality measures tied to HIV/AIDS care for the reporting period.
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Service type: Quality measure reporting and performance documentation related to HIV/AIDS care.
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Typical site of service: Ambulatory outpatient clinics, HIV specialty clinics, community health centers, and other outpatient settings where HIV/AIDS care and quality reporting occur.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient with known HIV infection presents to an outpatient infectious disease clinic for a comprehensive quality-of-care review and management visit. The interdisciplinary care team — typically including an infectious disease physician or HIV-specialist clinician, a nurse case manager, and a pharmacist — performs all required quality actions defined for the HIV/AIDS measures group: confirmatory documentation of antiretroviral therapy (ART) prescription and adherence counseling, viral load testing and review, CD4 count assessment, screening and treatment for opportunistic infections, linkage to support services, vaccination updates, and designated preventive screenings (e.g., hepatitis, sexually transmitted infections). The clinician documents each completed measure in the electronic health record during the visit or via chart review, and the practice applies billing code G8500 to indicate that all applicable HIV/AIDS quality actions have been performed for that patient during the measurement period. Typical workflow includes pre-visit chart reconciliation, in-visit medication reconciliation and counseling, ordering or reviewing lab results (HIV RNA and CD4), and care coordination tasks recorded as discrete elements to meet quality reporting requirements.
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 |