Summary & Overview
HCPCS G9002: Coordinated Care Fee, Maintenance Rate
HCPCS Level II code G9002 designates a coordinated care fee billed at a maintenance rate to cover ongoing care coordination activities. As payers and providers seek to align payments with value-based care models, a code like G9002 matters nationally because it captures discrete reimbursement for maintaining care plans, supporting transitions, and sustaining care management interventions that reduce fragmentation and prevent avoidable utilization. Key national payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical purpose of the code, how it is used across outpatient and ambulatory care settings, and what to expect in payer coverage patterns and billing practice given its role in care management portfolios. The publication provides benchmarks for maintenance-rate billing where available, summarizes relevant policy context affecting payment and coverage, and outlines common operational considerations for documenting and reporting ongoing coordination services. Data not available in the input will be noted where specific payer rates, taxonomies, or associated diagnoses are required but not provided.
Billing Code Overview
HCPCS Level II code G9002 represents a coordinated care fee, maintenance rate. The code describes a billed service intended to support ongoing care coordination activities tied to maintenance of a patient's care plan.
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Service type: Care coordination / maintenance of care management
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Typical site of service: Outpatient or ambulatory care settings where care coordination and ongoing management are provided, including clinic-based care management programs and care coordination services delivered as part of routine ambulatory care.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient enrolled in a coordinated care program presents for routine maintenance of an established chronic condition that requires multidisciplinary management and periodic administrative care coordination. Typical patients include older adults with multiple chronic conditions such as congestive heart failure, chronic obstructive pulmonary disease, diabetes with complications, or complex medication regimens who are assigned to a care coordinator or case manager. The service represented by G9002 is a maintenance rate for a coordinated care fee used to reimburse the practice or coordinating entity for ongoing activities that support care continuity.
A realistic workflow: the patient has a scheduled care coordination visit (in-person or telehealth) with a nurse care manager or social worker who reviews the patient’s status, medication adherence, recent hospital/ED use, and care plan goals. The care coordinator communicates with the primary care provider and relevant specialists, updates the problem list, arranges home health or durable medical equipment if needed, and documents care plan updates in the medical record. The practice bills G9002 as the maintenance coordinated care fee for the period after initial intensive coordination has been established to cover ongoing administrative and clinical coordination activities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 |