Summary & Overview
HCPCS G9037: Interprofessional Tele/Internet/EHR Consultation, 30 Minutes
HCPCS Level II code G9037 represents a 30-minute interprofessional clinical consultation conducted by telephone, internet, or through the electronic health record, where a treating or requesting clinician seeks specialty recommendations and may receive follow-up guidance. This non-face-to-face service captures specialist input that informs patient care without a direct patient-specialist encounter, and it reflects growing use of digital clinician-to-clinician communication across the health system.
Key national payers included in the discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and billing practices for interprofessional telecommunication services vary by payer and influence how health systems document, code, and aggregate remote specialty input.
Readers will gain a concise understanding of what G9037 represents clinically and operationally, the typical settings where the service occurs, and the implications for billing workflows. The publication also provides benchmarks and policy context relevant to adoption of interprofessional electronic consultations, outlines common documentation elements needed to support the service, and summarizes payer coverage patterns and recent policy updates where available. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G9037 describes an interprofessional consultation conducted by telephone, internet, or through the electronic health record in which a treating or requesting physician or other qualified health care professional seeks specialty recommendations for the care of a patient. The service includes the specialist’s recommendations and may include subsequent follow-up on those recommendations and is defined as a 30-minute interprofessional clinical question or request.
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Service type: Interprofessional consultation (telephone/internet/EHR clinical question and specialist recommendation)
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Typical site of service: Virtual/telehealth or clinician-to-clinician communication; applies to communications conducted remotely via telephone, internet-based platforms, or within the electronic health record.
Clinical & Coding Specifications
Clinical Context
A primary care physician managing a complex patient with multiple comorbidities requests specialty input from a cardiologist via secure electronic health record messaging. The primary clinician submits the patient history, current medications, recent labs, and asks whether the patient’s new-onset exertional dyspnea and an abnormal ECG require immediate cardiology-directed testing or a medication change. The cardiologist reviews the electronic record, requests clarification about the patient’s symptoms, and provides a 30-minute interprofessional consult with recommendations for diagnostic testing (stress testing and echocardiography), medication adjustments, and follow-up timing. The communication occurs entirely through the electronic health record and may include one or more asynchronous message exchanges and a focused telephone call between clinicians to clarify recommendations. Documentation includes the requesting clinician’s question, the specialist’s clinical assessment, recommended actions, and any follow-up plans. Billing is reported with G9037 for the specialist’s 30-minute interprofessional telephone/internet/EHR clinical consult for the requesting clinician’s care of the patient.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when the specialist’s interprofessional consult required substantially greater effort than typical (document rationale and time). |