G9404 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9404: Patient Did Not Receive Follow-Up Within 30 Days After Discharge

HCPCS Level II code G9404 denotes that a patient did not receive a documented follow-up within 30 days after discharge. The code flags gaps in post-discharge care transitions, an area of national priority due to its association with readmissions, care continuity, patient safety, and avoidable costs. Providers and health systems use this code to track unsuccessful transitions and to document efforts or outcomes related to follow-up scheduling and patient contact.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find national-level context about the role of G9404 in post-discharge quality measurement and billing workflows, an explanation of the clinical and administrative scenarios where the code applies, and what documentation typically supports its use. The publication also outlines common modifiers and related billing considerations where available, and highlights implications for care management programs and outpatient follow-up workflows.

The piece is intended to inform billing staff, care coordinators, and policy analysts about the purpose and operational use of G9404, clarify typical sites of service for tracking post-discharge follow-up, and summarize what elements are commonly reviewed when this code appears in claims. Data not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9404HCPCS Level IIpost-discharge carecare coordinationfollow-uptransitions of carehospital dischargequality measurement

Billing Code Overview

HCPCS Level II code G9404 indicates Patient did not receive follow-up within 30 days after discharge. This code documents the absence of a documented post-discharge follow-up contact or visit within the first 30 days after a patient’s discharge from a hospital or other inpatient setting.

Service Type: Post-discharge follow-up tracking / care coordination

Typical Site of Service: Hospital inpatient discharge transitions and outpatient follow-up settings, including primary care clinics, outpatient specialty clinics, and care management programs that track post-discharge follow-up completion.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient is discharged from an inpatient medical ward after treatment for congestive heart failure and is scheduled for a primary care follow-up within 7–14 days. The discharge plan identifies a timely post-discharge visit as required for medication reconciliation, assessment of volume status, and reinforcement of self-care. The clinic documents attempts to contact the patient but the patient does not attend and there is no completed follow-up visit within 30 days of discharge. In workflow terms: discharge summary is sent to the outpatient provider, clinic scheduling attempts an appointment, telephone outreach and portal messages are sent, and the absence of a completed visit within 30 days is recorded for care coordination and quality measurement purposes. The billing code G9404 is used to indicate the lack of a follow-up visit within the 30-day post-discharge window for reporting and quality reporting reconciliation rather than for direct reimbursement of a clinical service.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required to document or coordinate post-discharge activities is substantially greater than typical, if applicable to a billable service tied to the episode.

HCPCS G9765: Documentation of Systemic Therapy Decline or Contraindication

HCPCS-G9136-NON-HODGKIN-LYMPHOMA-TRANSFORMED-DISEASE-STATUS

HCPCS G9136: Non-Hodgkin Lymphoma, Transformed Disease Status

HCPCS-G9841-RAS-TESTING-NOT-PERFORMED-BEFORE-ANTI-EGFR-THERAPY

HCPCS G9841: Ras (KRAS and NRAS) Mutation Testing Not Performed Before Anti-EGFR Therapy

HCPCS-G9222-PNEUMOCYSTIS-PNEUMONIA-PROPHYLAXIS-LOW-CD4

HCPCS G9222: Pneumocystis jiroveci Pneumonia Prophylaxis, Low CD4

HCPCS-G0414-OPEN-TREATMENT-ANTERIOR-PELVIC-FRACTURE-INTERNAL-FIXATION

HCPCS G0414: Open Treatment of Anterior Pelvic Bone Fracture with Internal Fixation

HCPCS-G0066-CLINICAL-SOCIAL-WORK-MIPS-SPECIALTY-SET

HCPCS G0066: Clinical Social Work MIPS Specialty Set

HCPCS-G4029-PREVENTIVE-MEDICINE-MIPS-SPECIALTY-SET

HCPCS G4029: Preventive Medicine MIPS Specialty Set

HCPCS-G0277-HYPERBARIC-OXYGEN-THERAPY-FULL-BODY-CHAMBER-30-MIN

HCPCS G0277: Hyperbaric Oxygen Therapy, Full Body Chamber, 30-Min Intervals

HCPCS-G0316-PROLONGED-HOSPITAL-INPATIENT-OBSERVATION-E-M

HCPCS G0316: Prolonged Hospital Inpatient or Observation E/M, Per 15 Minutes

HCPCS-G2211-VISIT-COMPLEXITY-EVALUATION-MANAGEMENT-ADD-ON

HCPCS G2211: Visit Complexity for Ongoing or Focal E/M Services

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23

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Common outpatient clinician responsible for post-discharge follow-up visits.
`208D00000X`	Internal Medicine	Primary follow-up provider for complex medical discharges.
`207R00000X`	Nurse Practitioner	Often conducts post-discharge phone or clinic follow-up visits.
`208100000X`	Hospitalist	Manages inpatient discharge and coordinates outpatient follow-up.
`363L00000X`	Transitional Care/Case Management	Manages care transitions and documents missed follow-up within quality programs.

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

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common code for a routine primary care post-discharge follow-up visit that, if completed within 30 days, would negate the use of `G9404`.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used for more complex post-discharge follow-up requiring moderate to high medical decision making; documentation of this visit within 30 days is relevant to `G9404` reporting.
`99496`	Transitional care management services, interactive contact within 2 business days and face-to-face visit within 7–14 days (high complexity)	Represents structured transitional care that, when completed, addresses the same quality domain as `G9404`; absence of this service within the timeframe is captured by `G9404`.
`99495`	Transitional care management services, interactive contact within 2 business days and face-to-face visit within 14 days (moderate complexity)	Similar to `99496` for moderate complexity; completion would preclude reporting `G9404`.
`99358`	Prolonged evaluation and management service before and/or after direct patient care, non-face-to-face	Used when extensive non-face-to-face coordination occurs after discharge; documentation of such services is part of the workflow related to tracking follow-up and may be considered when determining applicability of `G9404`.

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