Summary & Overview
HCPCS G8902: Dementia Measures Group Reporting
HCPCS Level II code G8902 denotes the clinician's intent to report the dementia measures group, a set of quality measures focused on dementia care processes and outcomes. Nationally, structured reporting of dementia-related quality measures supports care coordination, performance monitoring, and value-based payment programs that emphasize quality measurement for cognitive disorders. The code signals participation in measurement activities rather than a discrete therapeutic or diagnostic procedure, and it can affect performance reporting at the provider and organization level.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code's clinical context and service implications, summaries of payer coverage patterns where available, and guidance on what documentation and reporting this code represents. The publication reviews benchmarks and measurement themes tied to dementia care quality, summarizes relevant policy or program updates affecting quality reporting, and highlights practical considerations for outpatient and ambulatory settings where dementia care is managed.
This summary is written for a national audience and focuses on the code's role in quality measurement and reporting for dementia care, helping stakeholders understand its purpose within clinical documentation and payer reporting frameworks.
Billing Code Overview
HCPCS Level II code G8902 describes the provider's intent to report the dementia measures group. This represents a bundled reporting designation used to indicate that a clinician or organization intends to report the set of quality measures that assess care for patients with dementia.
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Service type: Quality measurement and reporting activity related to dementia care
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Typical site of service: Ambulatory clinics, primary care practices, memory clinics, and other outpatient settings where dementia care and quality reporting occur
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Clinical & Coding Specifications
Clinical Context
A typical patient is an 78-year-old community-dwelling adult with progressive memory loss, difficulty with daily activities, and a prior diagnosis of Alzheimer disease. The patient attends a primary care or geriatric neurology clinic for a dementia care quality assessment visit tied to reporting the dementia measures group (G8902). The clinical workflow includes a focused history from the patient and caregiver, cognitive and functional assessment (documenting tools used and scores), medication review (including cognitive enhancers and antipsychotics), advance care planning discussion, evaluation for behavioral symptoms, and coordination of caregiver support and community resources. Relevant documentation elements recorded in the medical record include the dementia diagnosis and severity, cognitive testing results, medication reconciliation, care plan goals, counseling provided to the caregiver, and planned follow-up. The visit typically occurs in an outpatient clinic or office setting and may involve interdisciplinary team members such as a primary care physician, geriatrician, neurologist, nurse practitioner, social worker, or pharmacist.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure | Use when an E/M visit is distinct from the dementia quality reporting activity documented the same day |
59 | Distinct procedural service | Use when a separate, unrelated procedure is performed the same day as the dementia measure reporting |
76 | Repeat procedure or service by same physician | Use when the dementia measure reporting is repeated during the same encounter timeframe |
77 | Repeat procedure by another physician | Use when another physician repeats the dementia-related measure or documentation |
91 | Repeat clinical diagnostic laboratory test | Use if a repeated cognitive or laboratory test is required and reported separately |
GA | Waiver of liability statement on file (Medicare) | Use when patient or caregiver has signed a waiver relevant to services rendered in dementia care reporting contexts |
GZ | Item or service expected to be denied as not reasonable and necessary (Medicare) | Use when the dementia measure activity is furnished but documentation supports Medicare denial expectations |
JW | Drug amount discarded/not administered to any patient | Use when medication waste (e.g., unused injectable) is documented during a dementia clinic visit |
XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | Use when the dementia measure activity occurred in a different encounter from other services that day |
XC | Separate practitioner, service distinct because performed by a different practitioner | Use when a different practitioner documents the dementia measures reporting activity |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
2084P0800X | Geriatric Medicine | Specialists who commonly evaluate and manage dementia and report quality measures |
2084N0400X | Neurology | Neurologists who diagnose and stage neurodegenerative dementias and document measures |
207P00000X | Internal Medicine | Primary care physicians who manage dementia care and perform measure reporting |
363L00000X | Nurse Practitioner | Advanced practice clinicians frequently completing assessments, medication review, and caregiver counseling |
171V00000X | Social Worker | Behavioral and psychosocial care coordination and caregiver support documentation for measure reporting |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
G30.0 | Alzheimer's disease with early onset | Early-onset Alzheimer disease often triggers formal dementia staging and measure reporting |
G30.1 | Alzheimer's disease with late onset | Most common dementia diagnosis in older adults for which dementia quality measures are reported |
G30.9 | Alzheimer's disease, unspecified | Used when subtype is unspecified but dementia measures still apply |
F03.90 | Unspecified dementia without behavioral disturbance | Frequently used for general dementia reporting when behavioral symptoms are absent |
F02.80 | Dementia in other diseases classified elsewhere without behavioral disturbance | Used when dementia is secondary to another neurological disorder and quality measures are applicable |
F06.7 | Mild cognitive disorder | Used when cognitive impairment is present and monitoring/care planning via dementia measures is indicated |
R41.3 | Other amnesia | Memory impairment code that may appear in the diagnostic mix during assessment for dementia measures |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
90791 | Psychiatric diagnostic evaluation | Performed when a comprehensive psychiatric diagnostic assessment is needed to evaluate cognitive and behavioral symptoms alongside dementia measures reporting |
96127 | Brief emotional/behavioral assessment (e.g., depression inventory) | Used to screen for comorbid depression or behavioral symptoms during dementia quality assessment visits |
99483 | Assessment of and care planning for cognitive impairment, requiring a comprehensive history, caregiver interview, and cognitive testing | Commonly performed alongside dementia measures reporting; directly addresses care planning and documentation required for quality measures |
G0156 | Services of clinical psychologist in home health or other settings — per OASIS (Medicare) | Used when allied behavioral health services are provided as part of dementia care and measure-driven interventions |
92523 | Behavioral and qualitative analysis of voice/speech for cognitive communication disorders | Performed when speech-language evaluation is needed as part of functional assessment and care planning for dementia patients |