Summary & Overview
HCPCS G9482: Remote In-Home Evaluation and Management for New Patient
HCPCS Level II code G9482 designates a remote in-home evaluation and management visit for a new patient, intended for use within a Medicare-approved CMS Innovation Center demonstration. The visit is delivered via interactive audio and video technology and requires an expanded problem-focused history and examination with straightforward medical decision making. Typically lasting about 20 minutes, the service supports counseling and coordination of care for problems of low to moderate severity. Nationally, this code reflects policy and operational efforts to expand telemedicine access to patients at home under demonstration authorities and highlights issues around standardizing telehealth E/M definitions and coverage for new-patient virtual visits.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the code’s clinical and service context, the typical site of service, and the role of synchronous audiovisual technology in delivering the visit. The publication outlines what stakeholders need to understand about coding scope, common usage scenarios, and where to look for payer-specific coverage guidance and billing details. Data not available in the input for payer-specific reimbursement benchmarks, associated taxonomies, and ICD-10 pairings.
Clinical & Coding Specifications
Clinical Context
A 72-year-old Medicare beneficiary enrolled in a CMS Innovation Center demonstration presents for a first-time remote in-home visit using real-time audio and video technology. The patient reports new onset shortness of breath and increased lower extremity swelling over several days. A primary care physician or advanced practice provider conducts an expanded problem-focused history asking about symptom onset, progression, current medications, and social supports. A focused remote physical examination is performed via video (inspection of respiratory effort, peripheral edema, skin color, and guided auscultation if peripheral devices are available). Medical decision making is straightforward and limited in complexity; the clinician provides counseling on symptom management, reviews medications, and coordinates follow-up with a cardiologist and home health services as needed. The encounter typically lasts about 20 minutes and includes documentation of the three required components: expanded problem-focused history, expanded problem-focused examination, and straightforward medical decision making. The service is furnished in the patient’s home using interactive audio-video technology under the CMS demonstration project rules.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
95 | Synchronous telemedicine service rendered via real-time interactive audio and video | Use when the encounter is furnished live by audio-video technology. |