Summary & Overview
HCPCS G9868: Remote Asynchronous Dermatologic/Ophthalmologic Image Analysis, <10 min
HCPCS Level II code G9868 designates a brief, asynchronous clinical service: receipt and professional analysis of remote dermatologic or ophthalmologic images requiring less than 10 minutes of clinician time. The code is limited to use within Medicare-approved Center for Medicare & Medicaid Innovation (CMMI) models, reflecting targeted programmatic testing of telehealth imaging workflows. Nationally, the code matters because it formalizes short, store-and-forward image reviews for specialty evaluation, enabling standardized reporting and potential valuation within pilot payment models.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, how it aligns with remote specialty image evaluation workflows, and the policy context linking it to CMMI model use. The publication outlines expected service settings and use cases for dermatology and ophthalmology, common billing considerations, and where additional data are required. It describes benchmarks and policy updates where available and identifies gaps labeled "Data not available in the input" when specific payer policies, associated taxonomies, ICD-10 pairings, and related codes are not provided in the source material.
This summary is intended for national audiences seeking clarity on the code’s clinical scope, program restrictions, and implications for telehealth service reporting within Medicare innovation models.
Billing Code Overview
HCPCS Level II code G9868 covers the receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation, intended for use only within a Medicare-approved CMMI model. The service is defined as an asynchronous (store-and-forward) image review and assessment that takes less than 10 minutes of clinician time.
Service type: Remote asynchronous image analysis (telehealth/teledermatology or teleophthalmology)
Typical site of service: Remote/virtual evaluation performed outside a traditional clinic visit; clinician review occurs in an office or other professional setting using images submitted remotely.
Clinical & Coding Specifications
Clinical Context
A 67-year-old Medicare beneficiary enrolled in a Center for Medicare & Medicaid Innovation (CMMI) telehealth model takes photos of a suspicious skin lesion on their forearm using a secure patient portal. The primary care clinic’s medical assistant uploads the images and an intake note to the dermatology group asynchronously. A board-certified dermatologist later reviews the images and documentation remotely, performs clinical analysis, documents findings, and provides management recommendations without a real-time interaction. The service requires less than 10 minutes of the dermatologist’s time and is billed under G9868 for receipt and analysis of remote, asynchronous images for dermatologic evaluation within the CMMI model. Typical workflow steps: intake capture and upload, triage by clinic staff, asynchronous specialist review, documentation of findings and plan, and communication of recommendations to the patient and referring clinician. Typical site of service is an outpatient clinic or clinician office coordinating remote image submission; the technical capture may occur at the patient’s home. The typical patient scenario includes dermatologic concerns such as a new pigmented lesion, suspicious non-healing ulcer, or acute rash requiring specialist visual assessment without immediate in-person visit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/No modifier | Use when no specific modifier applies to the billed service |