Summary & Overview
HCPCS G9869: Remote Asynchronous Image Review for Dermatology/Ophthalmology
HCPCS Level II code G9869 covers the receipt and analysis of remote, asynchronous images for dermatologic and ophthalmologic evaluation within a Medicare-approved CMMI model for encounters lasting 10–20 minutes. The code formalizes a brief, clinician-led image review service that supports specialty triage, diagnostic clarification, and care planning without a synchronous visit. Nationally, the code matters because it codifies telehealth image-based specialty input in model-based care pathways and can affect how health systems route low-acuity specialty queries and capture clinician work for value-based programs.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical purpose of the code, typical sites of service, and the scope of services represented. The publication outlines what to expect in benchmarks and policy considerations for telemedicine image review services, summarizes typical use cases in dermatology and ophthalmology, and identifies where input was not provided. Data not available in the input are noted where applicable.
This summary is intended for a national audience of clinicians, billing staff, and policy analysts seeking a concise overview of HCPCS Level II code G9869 and its role in asynchronous image-based specialty evaluation within Medicare model care settings.
Billing Code Overview
HCPCS Level II code G9869 describes the receipt and analysis of remote, asynchronous images for dermatologic and/or ophthalmologic evaluation performed as part of a Medicare-approved CMMI model. The service duration specified is 10–20 minutes.
Service type: Asynchronous telemedicine image review and interpretation
Typical site of service: Outpatient clinic or remote/telehealth setting, where clinicians receive patient-submitted images for specialist review outside of a synchronous visit.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old Medicare beneficiary participating in a Medicare-approved CMMI (Center for Medicare & Medicaid Innovation) telehealth model sends asynchronous photos of a suspicious skin lesion on the forearm to a participating dermatology clinic via a secure patient portal. The originating site is the patient’s home; the receiving clinician is a board-certified dermatologist at an outpatient clinic. The clinic’s teledermatology nurse reviews image quality and demographics, then the dermatologist performs a remote, asynchronous review and documents analysis, triage recommendation (in-person evaluation, biopsy, or routine follow-up), and time spent. The service fits into a workflow where store-and-forward images are received, triaged by staff, and analyzed by the dermatologist within the 10–20 minute time range specified by the billing code G9869. Results and recommended next steps are communicated to the patient and referring provider via secure message and the electronic health record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Physician/supplier unmodified billing | Use when no modifier applies and billing is straightforward |
11 | Normal, default billing | Use to indicate a standard encounter without special circumstances |
22 | Increased procedural services | Use when work required is substantially greater than typically required |
23 | Unusual anesthesia | Not commonly used for this remote image analysis; rarely applicable |
52 | Reduced services | Use when service provided is less than described by G9869 |
53 | Discontinued procedure | Use if the analysis was started but discontinued for reasons beyond control |
54 | Surgical care only | Not routinely applicable to this remote asynchronous consult |
55 | Postoperative management only | Not routinely applicable to this consult service |
56 | Preoperative management only | Not routinely applicable; use if only preop advice was given |
62 | Two surgeons | Rare for this service; use if two physicians share responsibility for analysis |
78 | Return to operating room | Not applicable to this service except in unusual related surgical contexts |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Not applicable to remote image analysis but included if advanced practice provider documents service per payer policy |
QK | Medical direction of two or more CRNAs | Not applicable to this service but included as a commonly listed modifier set |
QX | CRNA service: CRNA with medical direction by a physician | Not applicable to this service |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Y00000X | Dermatology | Primary specialty performing remote dermatologic image analysis |
208000000X | Ophthalmology | Performs remote ophthalmologic image analysis when ocular images are submitted |
363L00000X | Telemedicine/Telehealth | Taxonomy for providers specializing in telehealth services and program administration |
208600000X | Optometry | May perform triage-level ophthalmic image assessments or preliminary reviews |
363A00000X | Nurse Practitioner | Frequently documents and coordinates store-and-forward workflows under physician oversight |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
L98.9 | Disorder of integument, unspecified | General code for skin conditions when a specific diagnosis is pending after image review |
L57.0 | Actinic keratosis | Common reason for dermatologic image evaluation to assess for suspicious precancerous lesions |
C44.9 | Malignant neoplasm of skin, unspecified | Used when images suggest a potential skin cancer that requires in-person evaluation or biopsy |
H11.129 | Conjunctival hemorrhage, unspecified eye | Example ophthalmologic presentation that may be evaluated via asynchronous images in teleophthalmology |
H02.83 | Dermatochalasis of eyelid | Ophthalmic adnexal condition that can be initially assessed with images for triage |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99421 | Online digital evaluation and management service, for an established patient, 5-10 minutes | May be used for follow-up electronic evaluation or messaging after image-based triage |
99422 | Online digital evaluation and management service, for an established patient, 11-20 minutes | May be used when the clinician provides an online E/M of similar time duration following image review |
99423 | Online digital evaluation and management service, for an established patient, 21 or more minutes | Applicable if clinician documents more extensive online evaluation beyond the 10–20 minute window |
99091 | Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient to the physician, 30 minutes | May be relevant in programs that combine image review with monitoring data; not routine for single-image analysis |
99457 | Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time | May be billed in broader remote monitoring programs accompanying teledermatology or teleophthalmology services |
99458 | Remote physiologic monitoring treatment management services, each additional 20 minutes | Ancillary for extended remote care management beyond the single asynchronous image analysis |