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    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g9488-remote-in-home-evaluation-established-patient
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    HCPCS G9488: Remote In-Home E/M Visit for Established Patient

    HCPCS Level II code G9488 describes a remote in-home evaluation and management visit for an established patient performed via real-time interactive audio and video technology as part of a Medicare Innovation Center demonstration project; the service type is a telehealth/telemedicine E/M visit requiring at least two of three components (detailed history, detailed exam, or medical decision making of moderate complexity), typically involving counseling and care coordination, and the typical site of service is the patient’s home with approximately 25 minutes spent in the encounter.

    For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease.

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    Clinical & Coding Specifications

    Clinical Context

    An established Medicare beneficiary with chronic congestive heart failure who is homebound participates in a scheduled remote in-home visit using interactive audio and video technology. The patient reports increased dyspnea and lower extremity edema over three days. During a 25-minute real-time video encounter, the clinician obtains a detailed history, performs a focused but detailed virtual examination (visual assessment of respiratory effort, jugular venous distention, peripheral edema, and medication adherence), and completes medical decision making of moderate complexity to adjust diuretic dosing and arrange same-week home health nursing and laboratory testing. Counseling and coordination of care occur with the patient’s cardiologist and a home health agency. The visit is furnished under a Medicare Innovation Center demonstration project and is billed using G9488.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesMay be used by payers for similar-level established patient E/M visits provided in-person; serves as a clinical benchmark for complexity comparison.
    99214Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutesClinically analogous to the 25-minute moderate-complexity virtual visit; some payers map G9488 visits to 99214 for payment parity.
    99453Remote monitoring of physiologic parameter(s) initial set-up and patient educationMay be used in conjunction with remote in-home visits when home monitoring devices are deployed and managed.
    99457Remote physiologic monitoring treatment management services, first 20 minutesUsed when ongoing remote monitoring and management complement the telehealth E/M visit within the care plan.
    99490Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional per calendar monthOften provided alongside telehealth evaluation for complex chronic conditions requiring care coordination.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    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…
    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…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RH0000XHematology (Internal Medicine) PhysicianAn internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
    207RG0300XGeriatric Medicine (Internal Medicine) PhysicianAn internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects o…
    207QG0300XGeriatric Medicine (Family Medicine) PhysicianA family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitati…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    364S00000XClinical Nurse SpecialistA registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses…
    261QL0400XLithotripsy Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    363LP2300XPrimary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    225700000XMassage TherapistAn individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hy…

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01
    Celiac Disease TestingOscar Health2026-10-01
    Laboratory Testing for the Diagnosis of Inflammatory Bowel DiseaseOscar Health2026-10-01
    Percutaneous Electrical Nerve Field Stimulation (PENFS)Cigna2026-09-15
    Colorectal Cancer ScreeningBlue Cross Blue Shield - New Mexico2026-09-04

    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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