G9515 HCPCS: Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9515: No Return to Operating Room within 90 Days

HCPCS Level II code G9515 denotes that a patient did not require a return to the operating room within 90 days of surgery. As an outcomes-focused HCPCS Level II code, G9515 captures postoperative course and surgical quality elements that matter for hospital reporting, bundled payment models, and payer post-acute reviews. It is relevant across inpatient and outpatient surgical settings where a 90-day surgical episode is used for quality or payment considerations. Key national payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise explanation of what G9515 represents, its clinical and administrative context, and the types of benchmarks and reporting uses tied to a 90-day return-to-OR metric. The publication outlines how G9515 is used in surgical episode monitoring, typical sites of service, and where this outcome metric intersects with payer review and bundled payment constructs. Where additional code-level or taxonomy details are required, the report notes when input data is not available. The content is framed for a national audience and intended to inform clinical, administrative, and policy stakeholders about the code's purpose and practical significance.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9515HCPCS Level IIpostoperative outcomereturn to operating room90-day postoperativesurgical qualityhospital services

Billing Code Overview

HCPCS Level II code G9515 indicates that the patient did not require a return to the operating room within 90 days of surgery. This code reflects a postoperative outcome measure focused on the absence of unplanned returns to the operating room during the 90-day postoperative period.

Service type: Postoperative outcome assessment
Typical site of service: Hospital inpatient or outpatient surgical settings where procedures with a 90-day postoperative window are performed

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult who underwent an inpatient or outpatient surgical procedure and completed postoperative follow-up without complications requiring reoperation within the 90-day global surgical period. For example, a 55-year-old patient undergoes elective laparoscopic cholecystectomy for symptomatic cholelithiasis. The operation is uncomplicated, the patient is discharged the same day or after a brief hospital stay, and routine postoperative visits at 1 week and 4 weeks document expected recovery. No wound problems, retained stones, bile leak, or postoperative bleeding occur that would necessitate a return to the operating room within 90 days.

Clinical workflow:

Preoperative evaluation and informed consent for the planned procedure.
Index surgical encounter with intraoperative documentation, anesthesia record, and immediate postoperative recovery notes.
Post-anesthesia and discharge documentation (if outpatient) or daily inpatient progress notes (if inpatient) with instructions for follow-up.
Scheduled postoperative visits during the global period (typically 10, 90 days depending on the procedure) documenting healing, symptom resolution, and any minor interventions managed nonoperatively.
If no return to the operating room occurs within 90 days, the encounter is eligible for reporting with the HCPCS Level II code G9515 to document the absence of reoperation within that interval.

Coding Specifications

HCPCS G2087: Office-Based Opioid Use Disorder Treatment, 60+ Minutes

HCPCS-G8856-REFERRAL-OTOLOGIC-EVALUATION

HCPCS G8856: Referral for Otologic Evaluation

HCPCS-G9296-SHARED-DECISION-MAKING-CONSERVATIVE-THERAPY-DISCUSSION

HCPCS G9296: Shared Decision-Making Including Conservative Therapy Discussion

HCPCS-G0446-INTENSIVE-BEHAVIORAL-THERAPY-CVD-15-MIN

HCPCS G0446: Annual Intensive Behavioral Therapy for Cardiovascular Disease, 15 min

HCPCS-G9077-PROSTATE-CANCER-ADENOCARCINOMA-T1-T2C-GLEASON-2-7-PSA-LE-20

HCPCS G9077: Prostate Cancer Disease Status, Localized Adenocarcinoma

HCPCS-G0544-POST-DISCHARGE-TELEPHONIC-FOLLOW-UP-BEHAVIORAL-HEALTH

HCPCS G0544: Post-Discharge Telephonic Follow-Up After ED Behavioral Health Discharge

HCPCS-G9472-DXA-NOT-ORDERED-NO-OSTEOPOROSIS-ASSESSMENT

HCPCS G9472: DXA Not Ordered; No Osteoporosis Assessment

HCPCS-G9416-TDAP-IMMUNIZATION-AGE-10-TO-13

HCPCS G9416: Tdap Vaccine Given Between Ages 10 and 13

HCPCS-G2011-ALCOHOL-SUBSTANCE-MISUSE-ASSESSMENT-BRIEF-INTERVENTION

HCPCS G2011: Alcohol/Substance Misuse Assessment with Brief Intervention

HCPCS-G9820-CHLAMYDIA-SCREENING-DOCUMENTATION-FOLLOW-UP

HCPCS G9820: Chlamydia Screening Test Documentation with Follow-Up

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Taxonomy Code	Specialty	Notes
207L00000X	General Surgery	Most common specialty performing abdominal, biliary, and many general operative procedures where return-to-OR metrics apply.
208000000X	Obstetrics and Gynecology	Performs gynecologic procedures with 90-day global periods where reoperation absence is tracked.
2086S0121X	Orthopedic Surgery	Joint, fracture, and soft-tissue procedures commonly have 90-day outcomes tracked for reoperation.
207RI0200X	Colon and Rectal Surgery	Procedures with potential early postoperative complications that could require reoperation.
2084P0800X	Plastic Surgery	Reconstructive procedures where unplanned returns to the operating room are quality metrics.

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
`47562`	Laparoscopic cholecystectomy; with cholangiography	Common index operative code for symptomatic gallbladder disease; `G9515` documents absence of return to OR after this procedure within 90 days.
`44970`	Laparoscopic appendectomy	Index operative code for appendectomy; absence of reoperation within 90 days is captured by `G9515` as a postoperative quality outcome.
`19307`	Mastectomy, partial (lumpectomy), or partial mastectomy with axillary node dissection	Example of a procedure with a 90-day global period where `G9515` indicates no return to the OR occurred.
`27130`	Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty)	Major orthopedic procedure with tracked 90-day complications; `G9515` reports no reoperation in that interval.
`58260`	Vaginal hysterectomy, for prolapse (partial or total)	Gynecologic procedure with postoperative surveillance; `G9515` applies when no return to OR is required within 90 days.

`22`	Increased procedural services	Use when work required for the procedure is substantially greater than typically required, documented and justified in the operative report.
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary for a procedure usually performed with local/regional anesthesia.
`52`	Reduced services	Use when a service or procedure is partially reduced or not completed, with documentation explaining reduction.
`53`	Discontinued procedure	Use when a procedure is terminated due to extenuating circumstances or patient safety concerns before completion.
`54`	Surgical care only	Use when the surgeon provides only the surgical component and another provider provides pre/postoperative care.
`55`	Postoperative management only	Use when the surgeon provides only postoperative management during the global period.
`56`	Preoperative management only	Use when the surgeon provides only preoperative evaluation and management.
`62`	Two surgeons	Use when two surgeons operate together as primary surgeons on distinct portions of the same procedure.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an assistant-at-surgery from these professions performs documented assisting duties.
`QX`	Modifier for separately billing physician assistant (PA) services	Use when services by a PA are billed and the PA meets state scope requirements.

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