G9407 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9407: Patient Did Not Receive Follow-Up Within 7 Days After Discharge

HCPCS Level II code G9407 documents instances when a patient did not receive a follow-up visit within seven days of hospital discharge. This measure is relevant to transitions-of-care quality monitoring and affects hospitals, post-acute providers, and care management programs nationwide. Tracking missed early follow-ups is important for patient safety, readmission risk assessment, and value-based care performance metrics.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical and administrative context, typical sites of service, and what the code represents for discharge management workflows. The publication summarizes benchmarking considerations, common billing modifiers reported with similar service lines (input provided), and notes where input data are unavailable.

The content outlines practical implications for coding and billing teams, care coordinators, and compliance staff responsible for documenting post-discharge follow-up activities. It also highlights areas where institutions may focus quality-improvement efforts to reduce missed early follow-ups. Data not available in the input where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9407HCPCS Level IIpost-discharge follow-upcare transitionsreadmission riskcare coordinationhospital dischargequality measureoutpatient follow-up

Billing Code Overview

HCPCS Level II code G9407 indicates Patient did not receive follow-up within 7 days after discharge. This code captures the occurrence of a missed or absent follow-up encounter within the first seven days following a patient’s hospital discharge.

Service type: Care coordination / post-discharge follow-up tracking
Typical site of service: Hospital discharge transitions, outpatient follow-up settings, or care coordination programs associated with inpatient-to-outpatient transitions

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult recently discharged from an inpatient psychiatric or medical hospitalization who does not complete a scheduled follow-up visit within seven days of discharge. For example, a 62-year-old patient admitted for decompensated congestive heart failure is discharged with a cardiology follow-up arranged for day 5 post-discharge; the patient misses the appointment and no visit occurs within seven days. Workflow: discharge planning staff schedule an outpatient follow-up appointment before discharge, document the planned appointment in the discharge summary, and instruct the patient on the importance of the visit. Post-discharge care coordinators or case managers attempt outreach; if contact cannot be re-established or the patient declines or misses the appointment, clinical records will document lack of follow-up within the 7-day window. The billing circumstance captured by G9407 is recorded by the facility or practitioner to indicate that a recommended or planned follow-up visit did not occur within 7 days after discharge.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when services are substantially greater than typical for an encounter related to discharge planning or complex coordination documented in the record.

HCPCS G9379: Patient Did Not Achieve Flat Retinas Six Months Post Surgery

HCPCS-G6028-HIGH-RESOLUTION-ANOSCOPY-WITH-BIOPSY

HCPCS G6028: High-Resolution Anoscopy with Biopsy

HCPCS-G9317-RISK-ASSESSMENT-MULTI-INSTITUTIONAL-CALCULATOR-NON-COMMUNICATED

HCPCS G9317: Patient-Specific Risk Assessment, Calculator Used, Communication Not Completed

HCPCS-G8432-DEPRESSION-SCREENING-NOT-DOCUMENTED

HCPCS G8432: Depression Screening Not Documented, Reason Not Given

HCPCS-G9227-FUNCTIONAL-OUTCOME-ASSESSMENT-NOT-ELIGIBLE-FOR-CARE-PLAN

HCPCS G9227: Functional Outcome Assessment, Care Plan Not Documented

HCPCS-G8666-SHOULDER-RESIDUAL-SCORE-NOT-MEASURED

HCPCS G8666: Shoulder Residual Score Not Measured

HCPCS-G8653-HIP-FUNCTIONAL-STATUS-NOT-MEASURED-PATIENT-NOT-APPROPRIATE

HCPCS G8653: Hip Functional Status Not Measured, Patient Not Appropriate

HCPCS-G8598-ASPIRIN-ANTIPLATELET-THERAPY-USED

HCPCS G8598: Aspirin or Other Antiplatelet Therapy Used

HCPCS-G6008-RADIATION-DELIVERY-2-AREAS-3PLUS-PORTS-6-10MEV

HCPCS G6008: Radiation Delivery to Two Areas, 3+ Ports on One Area

HCPCS-G9597-PEDIATRIC-MINOR-BLUNT-HEAD-TRAUMA-NOT-LOW-RISK-PECARN

HCPCS G9597: Pediatric Minor Blunt Head Trauma Not Low Risk

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
207Q00000X	Cardiology	Common specialty arranging early post-discharge follow-up for heart failure and other cardiac admissions.
207R00000X	Internal Medicine	Hospitalists and primary care physicians who arrange and provide early post-discharge visits.
2084P0800X	Psychiatry & Neurology	Psychiatric providers who schedule 7-day follow-ups after behavioral health admissions.
208D00000X	Family Medicine	Primary care clinicians who perform early post-discharge evaluations and transitional care.
363L00000X	Case Management	Care coordinators or discharge planners who document follow-up arrangements and outreach attempts.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.9`	Heart failure, unspecified	Heart failure admissions commonly require early post-discharge follow-up to reassess volume status and medications.
`J18.9`	Pneumonia, unspecified organism	Patients hospitalized for pneumonia frequently need early outpatient review of recovery, antibiotics tolerance, and oxygen needs.
`F32.9`	Major depressive disorder, single episode, unspecified	Behavioral health discharges require timely follow-up to monitor mood, safety, and medication adherence.
`N17.9`	Acute kidney failure, unspecified	Renal function reassessment soon after discharge is often necessary to adjust medications and fluids.
`E11.9`	Type 2 diabetes mellitus without complications	Diabetes management adjustments and wound or glycemic control review commonly occur after discharge.
`R55`	Syncope and collapse	Post-discharge evaluation may be needed to review causes and medication changes after admission for syncope.
`Z79.899`	Other long term (current) drug therapy	Indicates patients on chronic medications where early follow-up is important for monitoring therapy safety.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Common code for an outpatient follow-up visit that would satisfy the 7-day follow-up requirement if completed.
`99238`	Hospital discharge day management; final hospital discharge of patient	Performed at discharge when follow-up appointments are arranged; documentation here supports the planned 7-day follow-up.
`99495`	Transitional care management services with moderate medical decision complexity, face-to-face within 14 days of discharge	Used for post-discharge care coordination; a completed TCM visit within the specified timeframe is related to measuring follow-up adherence.
`99496`	Transitional care management services with high medical decision complexity, face-to-face within 7 days of discharge	Directly relevant when a high-complexity TCM visit is completed within 7 days; absence of such a visit may be coded with `G9407`.
`99490`	Chronic care management, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month	Ongoing care management codes that may be part of a broader strategy to ensure timely follow-up; not a substitute for the 7-day clinic visit.

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