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    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g9187-bundled-home-visit-patient-assessment-non-homebound
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    HCPCS G9187: Home Visit Assessment for Non‑Homebound Patients

    Medicare pays $53 on average nationally for this procedure.

    HCPCS Level II code G9187 describes a bundled payments for care improvement initiative home visit assessment performed by a qualified health care professional for individuals not considered homebound; the service type is a home visit assessment focused on safety, falls, clinical and fluid status, medication reconciliation/management, activities of daily living and appropriateness of care setting, and the typical site of service is the patient’s home as part of the Medicare-approved bundled payments for care improvement initiative (may not be billed for a 30-day period covered by a transitional care management code).

    For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.

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    Table of contents

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    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99441Telephone evaluation and management service by a physician or other qualified health care professional; 5-10 minutes of medical discussionMay be used before or after the home visit to triage symptoms or provide follow-up communication within the episode.
    99483Assessment of and care planning for a patient with cognitive impairment, 30 minutesMay be performed during a comprehensive home visit when cognitive assessment and care planning are required.
    99341Home visit for the evaluation and management of a new patient, typically 15-29 minutesA 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.
    99347Home visit for the evaluation and management of an established patient, typically 2-9 minutesShorter established-patient home visits performed for targeted checks or follow-up during the episode when appropriate.
    99495Transitional care management services with moderate complexity medical decision making (TCM) — medical decision complexity and follow-up within 14 daysG9187 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.
    99496Transitional care management services with high complexity medical decision making — follow-up within 7 daysAs with 99495, if TCM is billed for the applicable period, G9187 may not be billed concurrently.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –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…
    23Modifier -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…
    52Modifier ‑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…
    53Modifier 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…
    62Modifier 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…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    363LF0000XFamily Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    207Q00000XFamily Medicine PhysicianFamily 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…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    2081N0008XNeuromuscular Medicine (Physical Medicine & Rehabilitation) PhysicianA physician who specializes in neuromuscular medicine possesses specialized knowledge in the science, clinical evaluation and management of these diso…
    207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianA pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
    2086S0127XTrauma Surgery PhysicianTrauma surgery is a recognized subspecialty of general surgery. Trauma surgeons are physicians who have completed a five-year general surgery residenc…
    282E00000XLong Term Care HospitalLong-term care hospitals (LTCHs) furnish extended medical and rehabilitative care to individuals who are clinically complex and have multiple acute or…
    261QU0200XUrgent Care Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center

    Related ICD-10-CM Codes

    25 rows

    ICD-10-CM CodeDescription
    E11.9Type 2 diabetes mellitus without complications
    E78.5Hyperlipidemia, unspecified
    F01.50Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    F05Delirium due to known physiological condition
    F17.210Nicotine dependence, cigarettes, uncomplicated
    I10Essential (primary) hypertension
    I25.10Atherosclerotic heart disease of native coronary artery without angina pectoris
    I50.9Heart failure, unspecified
    J44.9Chronic obstructive pulmonary disease, unspecified
    M17.9Osteoarthritis of knee, unspecified

    Showing 1–10 of 25

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    7 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01
    Celiac Disease TestingOscar Health2026-10-01

    Related Codes

    HCPCS-G9490-HOME-ASSESSMENT-NON-HOMEBOUND

    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

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    Frequently Asked Questions

    References

    1. 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. 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. 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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