HCPCS G8761: Completion of Dementia Measures Quality Actions - OpenPayer

Summary & Overview

HCPCS G8761: Completion of Dementia Measures Quality Actions

HCPCS Level II code G8761 denotes that all required quality actions for the dementia measures group were completed for a patient. Nationally, accurate capture of this code supports measurement of dementia care quality, informs performance reporting, and can affect value-based payment programs tied to quality metrics. Adoption of standardized quality codes like G8761 helps health systems and payers track adherence to recommended care processes for patients with dementia.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical meaning and service implications of G8761, guidance on typical sites of service where it is used, and what benchmarks and policy updates to monitor related to dementia quality reporting. The summary clarifies how this code fits into quality documentation workflows and what national-level stakeholders review when assessing dementia care performance.

This publication does not provide individualized coding advice. Data not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG8761HCPCS Level IIdementia carequality measuresquality reportingoutpatient careperformance measurement

Billing Code Overview

HCPCS Level II code G8761 indicates that all quality actions for the applicable measures in the dementia measures group have been performed for this patient. This code documents completion of a set of quality-related care activities tied to dementia care measures.

Service type: Quality measurement and reporting related to dementia care
Typical site of service: Ambulatory or outpatient settings where dementia care quality measures are assessed, such as primary care clinics, memory clinics, and specialty outpatient practices

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an older adult diagnosed with dementia who receives comprehensive dementia care management within a primary care or geriatric clinic, memory disorders clinic, or home-based primary care program. The care team documents completion of all required quality actions for the dementia measures group (such as cognitive assessment, functional status evaluation, care planning, caregiver needs assessment, medication review for anticholinergics/antipsychotics, and discussion of advance care planning). The workflow begins with the clinician or qualified healthcare professional performing or confirming standardized cognitive testing and documenting baseline function, reviewing current medications for dementia-related risks, assessing behavioral symptoms, and addressing caregiver support and safety concerns. A care plan is documented in the medical record, including referrals (e.g., neurology, geriatrics, social work) as indicated and provision of education/resources. The clinician or quality coordinator then verifies that all applicable measure elements for the dementia group have been completed during the reporting period and assigns billing code G8761 to indicate that all quality actions for the applicable dementia measures were performed for that patient. Typical sites of service include outpatient primary care clinics, geriatric clinics, memory disorder specialty clinics, and home health or home-based primary care visits where dementia management is provided.

Coding Specifications

Modifier	Description	When to Use
`25`

HCPCS G8570: Prolonged Postoperative Intubation Not Required

HCPCS-G0504-PSYCHIATRIC-COLLABORATIVE-CARE-MANAGEMENT-ADDITIONAL-30MIN

HCPCS G0504: Psychiatric Collaborative Care Management, Additional 30 Minutes

HCPCS-G8599-ASPIRIN-OR-ANTIPLATELET-NOT-USED-REASON-NOT-GIVEN

HCPCS G8599: Aspirin or Antiplatelet Therapy Not Used, Reason Not Given

HCPCS-G9451-ONE-TIME-HCV-SCREENING

HCPCS G9451: One-Time Hepatitis C (HCV) Screening

HCPCS-G8849-REASON-NOT-PRESCRIBING-PAP-THERAPY

HCPCS G8849: Documentation of Reasons Not Prescribing PAP Therapy

HCPCS-G9858-PATIENT-ENROLLED-IN-HOSPICE

HCPCS G9858: Patient Enrolled in Hospice

HCPCS-G9368-HIGH-RISK-MEDICATION-ORDERS-NOT-ORDERED

HCPCS G9368: High-Risk Medication Orders Not Ordered

HCPCS-G9129-MULTIPLE-MYELOMA-DISEASE-STATUS-STAGE-II-PLUS

HCPCS G9129: Oncology Disease-Status Assessment for Multiple Myeloma

HCPCS-G9218-PCP-PROPHYLAXIS-NOT-PRESCRIBED-LOW-CD4

HCPCS G9218: PCP Prophylaxis Not Prescribed After Low CD4

HCPCS-G0482-DEFINITIVE-MASS-SPECTROMETRY-DRUG-TESTING-15-21-CLASSES

HCPCS G0482: Definitive Mass-Spectrometry Drug Test, 15–21 Drug Classes

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly manage dementia quality measures and document comprehensive care actions.
`207R00000X`	Internal Medicine	Internists provide outpatient dementia management and fulfill quality measure elements.
`207G00000X`	Geriatric Medicine	Geriatricians frequently complete dementia-specific quality measures and care plans.
`2084P0800X`	Neurology	Neurologists in memory clinics often perform cognitive assessments and document measure elements for dementia care.
`163W00000X`	Clinical Social Worker	Social workers perform caregiver assessments, care coordination, and resource linkage that contribute to dementia quality measures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G30.0`	Alzheimer's disease with early onset	Alzheimer's disease is a primary diagnosis for dementia quality measures; early onset patients require cognitive assessment, medication review, and care planning.
`G30.1`	Alzheimer's disease with late onset	Common dementia diagnosis included in measure sets for assessment and management actions.
`G30.9`	Alzheimer's disease, unspecified	Used when Alzheimer's is the suspected or documented cause of dementia and informs measure documentation.
`F02.80`	Dementia in other diseases classified elsewhere without behavioral disturbance, unspecified	Represents dementia due to another condition; quality actions apply similarly (assessment, care planning).
`F03.90`	Unspecified dementia, without behavioral disturbance	Frequently used when dementia type is not specified; quality measures target care and safety interventions.
`F01.50`	Vascular dementia without behavioral disturbance	Vascular dementia is another common etiology; relevant to medication review and vascular risk management within the dementia measures.
`F06.8`	Other specified mental disorders due to brain damage and dysfunction and to physical disease	Includes cognitive disorders due to medical conditions; quality actions still apply to assess and manage cognitive impairment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99406`	Smoking and tobacco use cessation counseling visit for intermediate interventions (3-10 minutes)	Rarely relevant directly; may be billed when tobacco cessation counseling is provided as part of overall preventive care during the same visit where dementia quality actions are completed.
`99406`	(Duplicate entry avoided)	(N/A)
`96116`	Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., dementia screening), per hour	Used for formal cognitive and neurobehavioral assessment that documents cognitive status elements included in dementia quality measures.
`96127`	Brief emotional/behavioral assessment (e.g., depression inventory), per standardized instrument	Used when standardized brief caregiver or patient behavioral assessments (e.g., depression screens) are performed as part of dementia quality actions.
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Used when advance care planning discussion and documentation are performed and count toward dementia care quality measures.
`99354`	Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (with concurrent or subsequent E/M)	Used when extended counseling or care planning time for dementia management and caregiver counseling occurs in addition to the standard visit and is documented accordingly.

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