Summary & Overview
HCPCS G8549: Completion of Hepatitis C Quality Measures
HCPCS Level II code G8549 denotes that all required quality actions for the hepatitis C measures group have been completed for a patient. Nationally, this code is used to document adherence to hepatitis C performance measures that track screening, diagnosis confirmation, linkage to care, treatment initiation, and follow-up activities. Accurate use of G8549 supports quality reporting programs and payer-driven value-based initiatives that monitor hepatitis C care pathways.
Key payers considered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical and reporting purpose, payer coverage context, and typical service settings. The publication summarizes benchmarks and reporting implications, highlights how the code fits into hepatitis C quality measurement workflows, and outlines relevant policy considerations and reporting updates affecting national quality programs.
The analysis is intended for clinicians, coding and billing staff, quality officers, and policy analysts seeking to understand how completion of hepatitis C measure bundles is captured in billing and reporting. Data not available in the input will be called out where applicable.
Billing Code Overview
HCPCS Level II code G8549 indicates that all quality actions for the applicable measures in the hepatitis C measures group have been performed for this patient. This code documents completion of the set of quality activities defined for hepatitis C performance reporting.
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Service type: Quality reporting and performance documentation for hepatitis C care
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Typical site of service: Outpatient clinical settings where hepatitis C care and quality measurement occur, including primary care clinics, specialty hepatology and infectious disease clinics, and ambulatory care centers
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a known or suspected hepatitis C virus (HCV) infection who is engaged in outpatient viral hepatitis care. The clinical workflow begins when the patient presents to a primary care clinic, infectious disease clinic, hepatology clinic, or community health center for HCV evaluation, treatment initiation, or follow-up. The care team documents completion of all required quality measures within the hepatitis C measures group for the reporting period. These quality actions commonly include verification of HCV RNA testing, assessment of HCV genotype when indicated, documentation of antiviral therapy initiation or referral for treatment, evaluation of liver fibrosis (transient elastography or laboratory markers), counseling on alcohol use and vaccination status (hepatitis A and B), and completion of follow-up viral load testing to confirm sustained virologic response or treatment response. The visit typically occurs in an outpatient ambulatory setting and may involve coordination among the primary clinician, nurse, case manager, and laboratory services. The billing code G8549 denotes that all applicable hepatitis C quality measure actions for this patient have been performed and recorded for quality reporting purposes.
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 |