G9686 Nursing Facility Conference HCPCS Reimbursement

HCPCS Level II code G9686 designates an onsite nursing facility conference conducted by a qualified practitioner together with at least one member of the nursing facility interdisciplinary care team. This code applies to conferences that are distinct from evaluation and management visits and are intended to facilitate coordinated care planning for nursing facility residents. Nationally, standardized reporting for interdisciplinary conferences supports care coordination, clarifies team responsibilities, and can influence facility-level quality measures and payer coverage determinations.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the code's scope and clinical context, an outline of typical sites of service and service components, and an overview of common considerations for billing and documentation. The publication also summarizes benchmarking and policy developments relevant to interdisciplinary nursing facility conferences, highlights areas where payer policies differ, and identifies operational implications for provider organizations.

Where specific payer or regulatory detail is not provided in the input, the text notes that data are not available. The content is intended for a national audience seeking clarity on the use and administrative context of HCPCS Level II code G9686.

Billing Code Overview

HCPCS Level II code G9686 describes an onsite nursing facility conference that is separate and distinct from an evaluation and management visit. The service includes a qualified practitioner and at least one member of the nursing facility interdisciplinary care team meeting at the nursing facility to discuss a resident's care.

Service type: Interdisciplinary care conference / care coordination visit

Typical site of service: Nursing facility (onsite)

Data not available in the input.

Clinical Context

A long-term care nursing facility initiates an interdisciplinary care conference for a frail, 84-year-old resident with multiple chronic conditions, including congestive heart failure and stage 3 chronic kidney disease. The facility’s nurse practitioner schedules an onsite nursing facility conference separate from any concurrent evaluation and management visit. The meeting includes the nurse practitioner, the resident’s primary nurse, a licensed clinical social worker, and a physical therapist to review goals of care, medication reconciliation, recent hospital readmission risk, and a care plan update. Documentation captures attendees, start and end times, issues addressed (e.g., changes in diuretics, fall risk mitigation, advance care planning), individualized recommendations, and patient or surrogate participation. Billing uses G9686 to report the conference as distinct from any evaluation and management service performed on the same day, ensuring the conference content, participants, and objectives are clearly documented in the medical record.

Coding Specifications

Modifier	Description	When to Use
`24`	Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period	Use when the conference is unrelated to a recent procedure and an E/M visit occurs during a global postoperative period.

Taxonomy Code	Specialty	Notes
`183500000X`	Nurse Practitioner	Common qualified practitioner leading or participating in onsite nursing facility conferences.
`364SF0000X`	Social Worker	Clinical social workers contribute to psychosocial assessment, advance care planning, and discharge planning.
`251B00000X`	Physical Therapist	PTs participate for functional status, mobility, and fall risk mitigation discussions.
`174400000X`	Internal Medicine Physician	Primary medical oversight and coordination of chronic disease management and medication changes.
`207Q00000X`	Family Medicine Physician	Family physicians commonly lead care team conferences in nursing facilities.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.33`	Acute on chronic systolic (congestive) heart failure	Frequent cause for interdisciplinary review of medications, fluid management, and readmission prevention.
`N18.3`	Chronic kidney disease, stage 3 (moderate)	Relevant for medication dosing, fluid balance, and coordination between nursing and renal care.
`R29.6`	Repeated falls	Falls trigger team conferences for fall risk assessment, environmental modifications, and therapy planning.
`F03.90`	Unspecified dementia without behavioral disturbance	Dementia often necessitates care planning, capacity assessment, and family/surrogate involvement in conferences.
`Z59.0`	Homelessness	Social determinants such as housing instability are discussed by interdisciplinary teams for discharge planning.
`Z63.5`	Disruption of family by separation or divorce	Family dynamics and caregiver availability commonly addressed during care conferences.
`Z51.81`	Encounter for therapeutic drug level monitoring	Medication monitoring and adjustment, including lab coordination, are common topics in facility conferences.
`R53.83`	Other fatigue	Functional decline and fatigue assessments inform interdisciplinary care plans.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99304`	Initial nursing facility care, per day, for the evaluation and management of a patient, typically 30 minutes	May be performed on the same day as the conference if a separate, documentable E/M visit occurs; documentation must support distinct services.
`99307`	Subsequent nursing facility care, per day, for the evaluation and management of a patient, typically 25 minutes	Commonly billed for routine daily E/M visits; if both a subsequent E/M and `G9686` occur, each must be distinct.
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Often discussed during interdisciplinary conferences when goals of care or advance directives are reviewed; billable when separate and time documented.
`96156`	Health behavior assessment or re-assessment, each 15 minutes	Behavioral health assessment conducted by social work or psychology staff during the conference may be reported when separately identifiable.
`99318`	Nursing facility discharge day management; 30 minutes and under	If the interdisciplinary conference functions as part of a discharge planning session, `99318` may be related when discharge management is performed and separately documented.
`G0156`	Service(s) performed by a social worker in the nursing facility for care planning	Social work services related to care planning in the facility that support the interdisciplinary conference; bill per payer rules.

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Summary & Overview

HCPCS G9686: Onsite Nursing Facility Interdisciplinary Conference