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    v1.0.28
    OpenPayerBilling CodesProcedures / Professional ServicesHCPCS hcpcs-g9489-remote-in-home-evaluation-management-established-patient
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    HCPCS G9489: Remote In-Home E/M for Established Patient, High Complexity

    Medicare pays $78 on average nationally for this procedure.

    HCPCS Level II code G9489 describes a remote in-home evaluation and management visit for an established patient provided via real-time interactive audio and video; the service requires at least two of three key components (comprehensive history, comprehensive examination, or medical decision making of high complexity), typically involves counseling and coordination of care, addresses problems of moderate to high severity, and usually entails about 40 minutes spent with the patient or family in the patient’s home via audiovisual technology.

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 72-year-old established Medicare beneficiary with multiple chronic conditions (congestive heart failure, chronic obstructive pulmonary disease, and type 2 diabetes) has worsening dyspnea and lower extremity edema over several days. The patient is homebound during participation in a Medicare-approved Center for Medicare & Medicaid Innovation (CMMI) demonstration project for remote in-home evaluation and management. The treating primary care physician or nurse practitioner schedules a real-time interactive audio-video visit using secure telehealth technology. During the 40-minute synchronous encounter the clinician obtains a comprehensive history, conducts a comprehensive visual and functional examination via video (including observation of respiration, edema, and medication administration), and performs medical decision making of high complexity. The clinician documents counseling and coordination of care with cardiology and home health agencies, adjusts medications, and arranges expedited in-person evaluation when necessary. The encounter is billed using G9489 to reflect the remote in-home E/M for an established patient under the CMMI demonstration project parameters.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99214Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutesMay be used for in-person visits of moderate complexity that correspond to lower-intensity E/M encounters compared to G9489
    99215Office or other outpatient visit for the evaluation and management of an established patient, typically 40 minutesClinically most analogous for time and complexity when an established patient requires high-complexity decision making in-person; serves as a comparator for medical necessity and documentation standards
    99441Telephone E/M service by a physician or other qualified health care professional, 5-10 minutes of medical discussionMay be used for audio-only follow-up or triage when interactive video is not available; lower complexity and time than G9489
    99457Remote physiologic monitoring treatment management services, physician/other qualified health care professional time in a calendar monthOften used adjunctively when remote monitoring data inform the high-complexity decisions made during the telehealth encounter
    99091Collection and interpretation of physiologic data digitally stored and/or transmitted by the patientRelated when clinical decisions during the remote visit rely on interpretation of patient-generated health data

    Related Modifiers

    5 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…
    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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    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…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    363LF0000XFamily Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    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…
    367A00000XAdvanced Practice MidwifeAdvanced practice midwifery encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproduc…
    133VN1101XGerontological Nutrition Registered DietitianAn individual who is a Specialist in Gerontological Nutrition and provides nutrition care to promote quality of life and optimal health for older adul…
    207YS0123XFacial Plastic Surgery PhysicianAn otolaryngologist who specializes in facial plastic surgery.

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    E03.9Hypothyroidism, unspecified
    E11.9Type 2 diabetes mellitus without complications
    E78.5Hyperlipidemia, unspecified
    F17.210Nicotine dependence, cigarettes, uncomplicated
    F32.9Major depressive disorder, single episode, unspecified
    F33.1Major depressive disorder, recurrent, moderate
    F41.9Anxiety disorder, unspecified
    G43.909Migraine, unspecified, not intractable, without status migrainosus
    H52.4Presbyopia
    I10Essential (primary) hypertension

    Showing 1–10 of 24

    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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