HCPCS G8942: Functional Outcome Assessment and Care Plan

HCPCS Level II code G8942 represents documentation of a functional outcome assessment using a standardized tool within the prior 30 days, with a care plan based on identified functional deficiencies documented within two days of that assessment; the service is a functional assessment and care planning encounter typically performed in home health or outpatient rehabilitation settings where standardized functional outcome measures guide short‑term care planning.

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Clinical & Coding Specifications

Clinical Context

A typical patient is an older adult recently discharged from an inpatient stay for exacerbation of chronic obstructive pulmonary disease or after a fall-related admission who requires a documented functional outcome assessment and timely care planning. Within 30 days, a clinician or allied health professional (for example, a physical therapist, occupational therapist, nurse case manager, or physician) administers a standardized functional outcome tool such as the Barthel Index, AM-PAC (Activity Measure for Post-Acute Care), or PROMIS physical function and documents the results in the medical record. Within two days of that assessment the clinician or interdisciplinary team documents a care plan that addresses identified deficits (mobility, self-care, fall risk, ADL/IADL needs), assigns responsible providers, specifies interventions (therapy orders, durable medical equipment, home health referral), and sets measurable goals. Typical sites of service include inpatient hospitals, skilled nursing facilities, long-term acute care hospitals, home health settings, outpatient rehabilitation clinics, and transitional care programs. The patient scenario often triggers when transition-of-care workflows or post-acute quality measures require a standardized functional assessment and a timely care plan to support safe discharge, reduce readmission risk, and coordinate post-discharge services. Common payors involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97110`	Therapeutic exercise to develop strength and endurance, range of motion and flexibility	Often performed by physical therapists before or after the functional assessment to address identified mobility deficits and document progress in the care plan.
`97530`	Therapeutic activities, direct (one-on-one) patient contact, each 15 minutes	Occupational or physical therapy interventions prescribed in the care plan to remediate functional deficits identified on assessment.
`99304`	Initial nursing facility care, per day, for the evaluation and management of a patient, typically 30 minutes	Physicians or NPs may document the standardized assessment and corresponding care plan during initial SNF evaluations.
`99495`	Transitional care management services with moderate medical decision complexity (face-to-face within 14 days)	Transitional care workflows often include functional assessments and care plans to support post-discharge follow-up and coordination.
`G0156`	Services of a qualified physical therapist in the home health or hospice setting, each 15 minutes	Home health PT visits implement care plan interventions based on the documented functional outcome assessment.
`G0438`	Annual wellness visit, initial, includes a personalized prevention plan of service (PPPS)	In outpatient or primary care contexts, functional assessments and care planning can be components of preventive or care coordination visits.

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
54	Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…	- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
225100000X	Physical Therapist	Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who…
225200000X	Physical Therapy Assistant	(1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accred…
208000000X	Pediatrics Physician	A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
163W00000X	Registered Nurse	(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
152WL0500X	Low Vision Rehabilitation Optometrist	Optometrists who specialize in low-vision care having training to assess visual function, prescribe low-vision devices, develop treatment plans, and r…
2083S0010X	Sports Medicine (Preventive Medicine) Physician	A preventive medicine physician who specializes in the diagnosis and treatment of sports related conditions and injuries.
1223X0008X	Oral and Maxillofacial Radiology Dentistry	The specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities …

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
E11.9	Type 2 diabetes mellitus without complications
E78.5	Hyperlipidemia, unspecified
F01.50	Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F32.9	Major depressive disorder, single episode, unspecified
G12.21	Amyotrophic lateral sclerosis
G30.9	Alzheimer's disease, unspecified
I69.391	Dysphagia following cerebral infarction
I69.398	Other sequelae of cerebral infarction
I69.911	Memory deficit following unspecified cerebrovascular disease
M16.11	Unilateral primary osteoarthritis, right hip

Showing 1–10 of 26

Related Payer Policy Updates

Specialty: Gastroenterology1 / 3

7 rows

Policy	Payer	Effective Date
Esophagogastroduodenoscopy (EGD) Coverage Policy	evicore	2026-11-05
Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)	univerahealthcare	2026-10-15
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing	Oscar Health	2026-10-01
Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease	Oscar Health	2026-10-01
Pancreatic Enzyme Testing for Acute Pancreatitis	Oscar Health	2026-10-01
Helicobacter pylori Testing	Oscar Health	2026-10-01
Celiac Disease Testing	Oscar Health	2026-10-01

HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Administration of Influenza Virus Vaccine

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of PrEP Drug for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling by Clinical Staff

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration, Person-Centered Assessment

Showing 1–10 of 1996

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`97110`	Therapeutic exercise to develop strength and endurance, range of motion and flexibility	Often performed by physical therapists before or after the functional assessment to address identified mobility deficits and document progress in the care plan.
`97530`	Therapeutic activities, direct (one-on-one) patient contact, each 15 minutes	Occupational or physical therapy interventions prescribed in the care plan to remediate functional deficits identified on assessment.
`99304`	Initial nursing facility care, per day, for the evaluation and management of a patient, typically 30 minutes	Physicians or NPs may document the standardized assessment and corresponding care plan during initial SNF evaluations.
`99495`	Transitional care management services with moderate medical decision complexity (face-to-face within 14 days)	Transitional care workflows often include functional assessments and care plans to support post-discharge follow-up and coordination.
`G0156`	Services of a qualified physical therapist in the home health or hospice setting, each 15 minutes	Home health PT visits implement care plan interventions based on the documented functional outcome assessment.
`G0438`	Annual wellness visit, initial, includes a personalized prevention plan of service (PPPS)	In outpatient or primary care contexts, functional assessments and care planning can be components of preventive or care coordination visits.

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
53	Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…	- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
54	Modifier ‑54 (“Surgical care only”) is appended to a CPT surgical procedure when the reporting surgeon performs the intraoperative (surgical) component but does not furnish the preoperative and/or…	- Use modifier -54 when the reporting surgeon provided only the intraoperative (surgical) component of a procedure and preoperative and/or postoperative management has been or will be provided by…
55	Modifier –55 indicates the billing provider furnished only postoperative management for a procedure that has a global surgical period. According to AAPC, this modifier is appended to the same CPT…	- Use modifier -55 when billing the same CPT surgical code that has a 10- or 90-day global period and you, as a provider other than the original surgeon, furnished ONLY postoperative management (no…
56	Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…	- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
225100000X	Physical Therapist	Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who…
225200000X	Physical Therapy Assistant	(1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accred…
208000000X	Pediatrics Physician	A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
163W00000X	Registered Nurse	(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
152WL0500X	Low Vision Rehabilitation Optometrist	Optometrists who specialize in low-vision care having training to assess visual function, prescribe low-vision devices, develop treatment plans, and r…
2083S0010X	Sports Medicine (Preventive Medicine) Physician	A preventive medicine physician who specializes in the diagnosis and treatment of sports related conditions and injuries.
1223X0008X	Oral and Maxillofacial Radiology Dentistry	The specialty of dentistry and discipline of radiology concerned with the production and interpretation of images and data produced by all modalities …

Related ICD-10-CM Codes

26 rows

ICD-10-CM Code	Description
E11.9	Type 2 diabetes mellitus without complications
E78.5	Hyperlipidemia, unspecified
F01.50	Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F32.9	Major depressive disorder, single episode, unspecified
G12.21	Amyotrophic lateral sclerosis
G30.9	Alzheimer's disease, unspecified
I69.391	Dysphagia following cerebral infarction
I69.398	Other sequelae of cerebral infarction
I69.911	Memory deficit following unspecified cerebrovascular disease
M16.11	Unilateral primary osteoarthritis, right hip

Showing 1–10 of 26

Related Payer Policy Updates

Specialty: Gastroenterology1 / 3

7 rows

Policy	Payer	Effective Date
Esophagogastroduodenoscopy (EGD) Coverage Policy	evicore	2026-11-05
Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)	univerahealthcare	2026-10-15
Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing	Oscar Health	2026-10-01
Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease	Oscar Health	2026-10-01
Pancreatic Enzyme Testing for Acute Pancreatitis	Oscar Health	2026-10-01
Helicobacter pylori Testing	Oscar Health	2026-10-01
Celiac Disease Testing	Oscar Health	2026-10-01

HCPCS G9490: Home Visit Patient Assessment for Non-Homebound Beneficiary

HCPCS-G0008-INFLUENZA-VACCINE-ADMINISTRATION

HCPCS G0008: Administration of Influenza Virus Vaccine

HCPCS-G0009-PNEUMOCOCCAL-VACCINE-ADMINISTRATION

HCPCS G0009: Administration of Pneumococcal Vaccine

HCPCS-G0010-HEPATITIS-B-VACCINE-ADMINISTRATION

HCPCS G0010: Administration of Hepatitis B Vaccine

HCPCS-G0011-PREP-COUNSELING-HIV-RISK-REDUCTION-ADHERENCE

HCPCS G0011: Individual PrEP Counseling, HIV Risk Assessment

HCPCS-G0012-PRE-EXPOSURE-PROPHYLAXIS-INJECTION-HIV-PREVENTION

HCPCS G0012: Injection of PrEP Drug for HIV Prevention

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling by Clinical Staff

HCPCS-G0017-PSYCHOTHERAPY-CRISIS-FIRST-60-MINUTES-NON-OFFICE

HCPCS G0017: Psychotherapy for Crisis, First 60 Minutes

HCPCS-G0018-PSYCHOTHERAPY-CRISIS-ADDITIONAL-30-MINUTES-NON-OFFICE

HCPCS G0018: Psychotherapy for Crisis, Additional 30 Minutes

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration, Person-Centered Assessment

Showing 1–10 of 1996

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS G8942: Functional Outcome Assessment and Care Plan

Sign up for hcpcs G8942 policy alerts

HCPCS G8942: Functional Outcome Assessment and Care Plan

Sign up for hcpcs G8942 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

HCPCS G8942: Functional Outcome Assessment and Care Plan

Sign up for hcpcs G8942 policy alerts

HCPCS G8942: Functional Outcome Assessment and Care Plan

Sign up for hcpcs G8942 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What clinical activity does HCPCS G8942 describe?

Which providers or specialties commonly perform and document the work described by G8942?

What specific documentation elements and timelines are required to support billing G8942?

Are there modifiers that may be reported with G8942 and when would they be used?

What procedure codes are commonly associated with or related to services documented with G8942?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What clinical activity does HCPCS G8942 describe?

Which providers or specialties commonly perform and document the work described by G8942?

What specific documentation elements and timelines are required to support billing G8942?

Are there modifiers that may be reported with G8942 and when would they be used?

What procedure codes are commonly associated with or related to services documented with G8942?

References