G9187 HCPCS Home Visit Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G9187: Bundled Home Visit Patient Assessment, Non-Homebound

HCPCS Level II code G9187 designates a bundled-payments home visit for patient assessment provided to individuals who are not considered homebound, intended for use within the Medicare-approved Bundled Payments for Care Improvement Initiative. The code captures a comprehensive home-based assessment — safety, falls, clinical and fluid status, medication reconciliation, adherence to care plans, activities of daily living, and evaluation of appropriate care setting — performed by a qualified health care professional. Nationally, this code matters because it formalizes payment reporting for transitional care models focused on reducing readmissions and improving post-acute outcomes in non-homebound patients.

Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will learn how the code is defined and used in bundled-payment contexts, the typical clinical scenarios and site of service, and the payer landscape relevant to national programs. The publication also summarizes available benchmarks and policy considerations for bundled care models and highlights where input data are not available. Data not provided in the input are noted as such rather than assumed.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicareG9187HCPCS Level IIbundled paymentshome visitpatient assessmenttransitional carepost-acute caremedication reconciliation

Billing Code Overview

HCPCS Level II code G9187 describes a bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound. The service includes assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, and evaluation of appropriateness of care setting. The description specifies use only in the Medicare-approved bundled payments for care improvement initiative and notes that the service may not be billed for a 30-day period covered by a transitional care management code.

Service Type: Home visit — patient assessment under bundled payments for care improvement initiative

Typical Site of Service: Patient's residence (home visit) for individuals not considered homebound

Data not available in the input for: associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A home visit performed under G9187 is provided to a non-homebound Medicare beneficiary enrolled in a Bundled Payments for Care Improvement (BPCI) initiative. Typical scenario: an older adult recently discharged from the hospital for congestive heart failure returns to independent living but has complex needs. A qualified healthcare professional (for example, a registered nurse or advanced practice provider) schedules a home visit within the BPCI episode window to assess safety, fall risk, fluid status, medication reconciliation, adherence to the discharge plan, activities of daily living, and appropriateness of care setting. The clinician performs a structured assessment, documents vital signs and weight, reviews current medications (identifying discrepancies or nonadherence), evaluates the home environment for hazards, assesses mobility and assistive devices, reviews wound or incision status if applicable, and communicates findings to the primary care team or case manager. If needed, the clinician arranges interventions such as referrals to home health services, durable medical equipment, or outpatient follow-up. This visit is not billed when a Transitional Care Management (TCM) service covers the same 30-day period. Typical site of service is the patient’s residence (private home or assisted-living setting). Common participants include the visiting clinician, the patient, and often a caregiver or family member.

Coding Specifications

Modifier	Description	When to Use
`11`

HCPCS G9594: Head CT Ordered for Minor Blunt Head Trauma

HCPCS-G9305-ANASTOMOSIS-NO-INTERVENTION-FOR-LEAK

HCPCS G9305: No Intervention for Anastomotic Leak

HCPCS-G9909-DOCUMENTED-REASON-NO-TOBACCO-CESSATION-INTERVENTION

HCPCS G9909: Documentation of Medical Reason for No Tobacco Cessation Intervention

HCPCS-G0409-SOCIAL-WORK-PSYCHOLOGICAL-SERVICES-CORF-INDIVIDUAL-15-MIN

HCPCS G0409: Social Work and Psychological Services, Individual, 15 Minutes

HCPCS-G9986-REMOTE-IN-HOME-EVALUATION-MANAGEMENT-ESTABLISHED-PATIENT

HCPCS G9986: Remote In-Home Evaluation and Management for Established Patients

HCPCS-G8876-BREAST-BIOPSY-NO-MINIMALLY-INVASIVE-BIOPSY-DOCUMENTATION

HCPCS G8876: Documentation for Not Performing Minimally Invasive Breast Biopsy

HCPCS-G9914-PATIENT-INITIATED-ANTI-TNF-THERAPY

HCPCS G9914: Patient-Initiated Anti-TNF Therapy

HCPCS-G9128-MULTIPLE-MYELOMA-DISEASE-STATUS-SMOLDERING-STAGE-I

HCPCS G9128: Multiple Myeloma Disease Status Assessment, Smoldering/Stage I

HCPCS-G9034-ZANAMIVIR-INHALATION-POWDER-INHALER-10MG

HCPCS G9034: Zanamivir Inhalation Powder, Inhaler, 10 mg

HCPCS-G0279-DIAGNOSTIC-DIGITAL-BREAST-TOMOSYNTHESIS

HCPCS G0279: Diagnostic Digital Breast Tomosynthesis

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`1835P2300X`	Nurse Practitioner	NPs commonly perform BPCI home assessments, medication reconciliation, and care coordination.
`363LF0000X`	Registered Nurse	RNs perform in-home assessments, education, wound checks, and fall-risk evaluation.
`367SP0200X`	Physician Assistant	PAs may perform the visit and document findings under applicable payer rules.
`207Q00000X`	Family Medicine Physician	Primary care physicians may oversee or receive communications from the home-visit clinician.
`207R00000X`	Internal Medicine Physician	Hospitalists or primary internists coordinate follow-up based on the assessment.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.33`	Acute on chronic diastolic (congestive) heart failure	Fluid-status assessment, weight checks, and medication reconciliation are core components of the home visit.
`I50.9`	Heart failure, unspecified	Broad relevance for patients requiring home-based assessment post-discharge.
`R29.6`	Repeated falls	Falls assessment and home safety evaluation are key visit elements.
`Z91.81`	History of falling	Guides focused fall-prevention interventions and education during the visit.
`Z91.19`	Patient noncompliance with medication regimen	Medication reconciliation/management is a primary reason for the home assessment.
`Z74.3`	Need for continuous supervision	Assessment of activities of daily living and appropriateness of care setting is relevant when supervision needs are identified.
`E86.0`	Dehydration	Fluid-status assessment during the home visit identifies dehydration risks and need for intervention.
`R63.5`	Abnormal weight gain	Rapid weight change is relevant in heart failure management and home monitoring.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99441`	Telephone evaluation and management service by a physician or other qualified health care professional; 5-10 minutes of medical discussion	May be used before or after the home visit to triage symptoms or provide follow-up communication within the episode.
`99483`	Assessment of and care planning for a patient with cognitive impairment, 30 minutes	May be performed during a comprehensive home visit when cognitive assessment and care planning are required.
`99341`	Home visit for the evaluation and management of a new patient, typically 15-29 minutes	A commonly used CPT for in-home E/M visits; may be performed alongside BPCI assessment when payer rules allow separate billing outside the bundled BPCI payment window.
`99347`	Home visit for the evaluation and management of an established patient, typically 2-9 minutes	Shorter established-patient home visits performed for targeted checks or follow-up during the episode when appropriate.
`99495`	Transitional care management services with moderate complexity medical decision making (TCM) — medical decision complexity and follow-up within 14 days	`G9187` may not be billed for a 30-day period covered by a TCM code; `99495` is commonly considered when TCM applies and will exclude `G9187` billing for that period.
`99496`	Transitional care management services with high complexity medical decision making — follow-up within 7 days	As with `99495`, if TCM is billed for the applicable period, `G9187` may not be billed concurrently.

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