Summary & Overview
HCPCS G9671: Intent to Report Diabetic Retinopathy Measures Group
HCPCS Level II code G9671 denotes a provider’s intent to report the diabetic retinopathy measures group, signaling participation in quality measurement for diabetic eye disease. Nationally, such intent codes matter because they support standardized reporting of care quality, facilitate value-based payment models, and help track adherence to evidence-based screening and management for diabetic retinopathy across outpatient settings.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical and administrative purpose, the typical service contexts where it is used, and which major payers recognize or require such reporting intent for quality programs. The publication summarizes national benchmarking implications, recent policy updates affecting quality reporting mechanisms, and clinical context relevant to diabetic retinopathy screening and management.
This coverage-oriented summary outlines what users can expect: definitions and usage of the code, payer applicability, and the role of the code in quality measurement and value-based programs. Specific billing modifiers, taxonomies, ICD-10 pairings, and related codes are not listed here; those items are identified in dedicated sections. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code G9671 indicates the provider's intent to report the diabetic retinopathy measures group. The service type is quality reporting / measures group reporting, documenting intention to submit performance data for diabetic retinopathy-related quality measures. The typical site of service is outpatient or ambulatory settings where diabetic eye care and quality reporting occur, including ophthalmology and optometry clinics and outpatient hospital or clinic encounters.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a 12-year history of type 2 diabetes presents to an ophthalmology clinic for an annual diabetic eye exam. The clinician documents intention to report the diabetic retinopathy measures group using G9671 to confirm participation in a quality reporting program. The clinical workflow includes: pre-visit review of diabetes history and last HbA1c, visual acuity testing, dilated fundus examination or retinal imaging (wide-field fundus photography or optical coherence tomography as indicated), documentation of retinopathy status (no retinopathy, nonproliferative, or proliferative), and counseling on follow-up interval and diabetic control. Imaging and exam findings are entered into the medical record, and the practice’s quality reporting submission is prepared to include the diabetic retinopathy measures group via G9671. Typical site of service is an ophthalmology or optometry clinic within an outpatient ambulatory setting. Typical patient scenario includes routine surveillance for diabetic retinopathy, screening in asymptomatic patients, or follow-up assessments for known retinopathy to meet quality measurement reporting requirements for payors.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day |