HCPCS G9006: Coordinated Care Fee, Home Monitoring - OpenPayer

Summary & Overview

HCPCS G9006: Coordinated Care Fee, Home Monitoring

HCPCS Level II code G9006 designates a coordinated care fee for home monitoring services and captures the administrative and clinical coordination required for remote patient oversight. Nationally, codes like G9006 matter as payers and providers expand telehealth and remote monitoring programs to manage chronic disease, reduce avoidable acute care use, and support value-based care models.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise primer on the code’s clinical context and service setting, an overview of typical payer coverage considerations, and what elements are commonly examined in benchmarking and policy discussions related to home monitoring coordination fees.

This publication presents: an explanation of the service represented by the code; common payer approaches to covering coordinated care fees for home monitoring; the types of benchmarks and reimbursement elements stakeholders track; and relevant policy and billing considerations affecting remote monitoring programs. Data not available in the input will be noted as such where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9006HCPCS Level IIhome monitoringcoordinated careremote patient monitoringtelehealthcare coordinationbilling

Billing Code Overview

HCPCS Level II code G9006 describes a coordinated care fee specifically for home monitoring services. This code represents a bundled administrative and clinical coordination payment intended to support remote patient monitoring activities that facilitate ongoing oversight of a patient’s condition outside of a traditional facility visit.

Service Type: Home monitoring and coordinated care management

Typical Site of Service: Patient home (remote/home-based monitoring)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with a chronic cardiopulmonary or endocrine condition (for example, heart failure, COPD, or insulin-requiring diabetes) enrolled in a home monitoring program that collects physiologic data (weight, blood pressure, pulse oximetry, glucose) remotely. The patient has intermittent symptoms or objective alerts (weight gain, rising blood pressure, falling oxygen saturation, or out-of-range glucose) that trigger a coordinated care workflow. A home health nurse or remote monitoring technician reviews incoming device data and documentation daily, notifies the supervising clinician of clinically significant trends, and implements care-plan adjustments per standing orders. The coordinated care fee covers care team activities to integrate home monitoring data, triage alerts, document coordinated interventions, arrange urgent outpatient visits or emergency services if needed, and communicate with the patient and caregivers.

Typical workflow steps:

Patient devices transmit data to the monitoring platform on a scheduled basis.
Remote monitoring staff review and triage alerts, escalate to the clinician for abnormal values.
Clinician/advanced practice provider reviews aggregated data, updates medication or orders diagnostics.
Care coordination staff arrange follow-up visits, home health, or ED referral and document actions in the medical record.
Billing staff apply the G9006 coordinated care fee for home monitoring when the documented activities meet payer policy criteria.

Coding Specifications

HCPCS G0557: Advanced Primary Care Management for Complex Chronic Patients

HCPCS-G9400-DOCUMENTATION-TREATMENT-DISCUSSION-OMISSION-REASONS

HCPCS G9400: Documentation of Reasons for Not Discussing Treatment Options

HCPCS-G9102-GASTRIC-ADENOCARCINOMA-DISEASE-STATUS-ASSESSMENT

HCPCS G9102: Gastric Adenocarcinoma Disease Status Assessment

HCPCS-G0077-LIMITED-CARE-MANAGEMENT-HOME-VISIT-NEW-PATIENT-30MIN

HCPCS G0077: Limited 30-Minute Care Management Home Visit

HCPCS-G8705-DOCUMENTATION-NO-12-LEAD-ECG

HCPCS G8705: Documentation of Medical Reason(s) for Not Performing a 12-Lead ECG

HCPCS-G8999-MOTOR-SPEECH-FUNCTIONAL-LIMITATION-ASSESSMENT

HCPCS G8999: Motor Speech Functional Limitation Assessment

HCPCS-G8855-ADHERENCE-ASSESSMENT-NOT-DOCUMENTED

HCPCS G8855: Adherence to Therapy Not Assessed, Reason Not Given

HCPCS-G9007-COORDINATED-CARE-TEAM-CONFERENCE

HCPCS G9007: Coordinated Care Fee for Scheduled Team Conference

HCPCS-G2148-MULTIMODAL-PAIN-MANAGEMENT

HCPCS G2148: Multimodal Pain Management Was Used

HCPCS-G8600-IV-THROMBOLYTIC-THERAPY-WITHIN-4-5-HOURS

HCPCS G8600: IV Thrombolytic Therapy Within 4.5 Hours of Last Known Well

Showing 1–10 of 1996

`22`	Increased procedural services	When the coordinated care activities require substantially greater resources or complexity than typical for `G9006` and documentation supports increased work.
`23`	Unusual anesthesia	Rarely applicable; use only if unplanned general anesthesia is required during an in-person escalation tied to monitoring activities.
`52`	Reduced services	When the home monitoring coordinated care activities are partially reduced or incomplete relative to the full service.
`53`	Discontinued procedure	When the coordinated care service is started but terminated due to patient instability or other uncontrollable events.
`54`	Surgical care only	Not typically applicable; included for completeness when surgical teams bill related perioperative coordination separate from the monitoring fee.
`55`	Postoperative management only	Use if billing only for postoperative coordination related to home monitoring after a surgical episode.
`56`	Preoperative management only	Use if billing only for preoperative coordination activities tied to home monitoring.
`62`	Two surgeons	Use if two providers of equal specialty bill for shared, simultaneous management when applicable to an in-person escalation from monitoring.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Rarely applicable; include only when allied providers function in an assisting role during an escalated in-person procedure.
`CQ`	Service furnished by a physician when a substitute physician/nurse practitioner is unavailable	Use when the billing physician personally furnishes the coordinated care service in lieu of the usual designated practitioner.
`QK`	Medical direction of two or more assistants at surgery	Generally not applicable; include only when applicable to an operative event tied to monitoring escalation.
`QX`	CRNA service with medical direction by a physician	Relevant only if anesthesia services are billed during an escalated procedure originating from monitoring.
`QY`	Locum tenens service — physician billing for a substitute	Use when a locum tenens provider furnishes the coordinated care service.
`TG`	Service delivered via interactive audio and video telecommunication systems	Use when the coordinated care activities are provided through synchronous telehealth (video) modalities as allowed by payer policy.

Taxonomy Code	Specialty	Notes
`174400000X`	Internal Medicine	Common supervising specialty for chronic disease home monitoring programs.
`207Q00000X`	Family Medicine	Primary care oversight of home monitoring and care coordination.
`207L00000X`	Cardiovascular Disease (Cardiology)	Manages patients with heart failure or other cardiac conditions monitored at home.
`363LF0000X`	Registered Nurse (RN)	Performs daily review, triage, patient education, and documentation for the monitoring program.
`363LA2200X`	Nurse Practitioner	Provides clinical decision-making, medication adjustment, and direct patient management for escalated alerts.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99457`	Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver	Frequently billed alongside `G9006` when active remote monitoring devices and clinical management meet time requirements.
`99458`	Remote physiologic monitoring treatment management services, each additional 20 minutes	Used to report additional monthly management time beyond the first 20 minutes in complex monitoring cases paired with `G9006`.
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient to the physician or other qualified healthcare professional, requiring a minimum of 30 minutes of time	May be used for higher-intensity data review and interpretation that supports the coordinated care activities billed with `G9006`.
`99453`	Remote monitoring of physiologic parameter(s); initial set-up and patient education on use of equipment	Billed when initiating a home monitoring program; typically performed before ongoing coordinated care services captured by `G9006`.
`99454`	Remote monitoring of physiologic parameter(s) for daily recordings or programmed alert transmission, each 30 days	Covers device data transmission and device supply, commonly reported in the monitoring workflow along with the coordinated care fee `G9006`.

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