Summary & Overview
HCPCS G9870: Remote Dermatologic and Ophthalmologic Image Analysis (>20 min)
HCPCS Level II code G9870 covers receipt and analysis of remote, asynchronous images for dermatologic and ophthalmologic evaluation when performed as part of a Medicare-approved Center for Medicare & Medicaid Innovation (CMMI) model and the professional work exceeds 20 minutes. Nationally, this code formalizes payment for extended, non–real-time image-based reviews that support diagnostic triage, monitoring of skin and eye conditions, and remote specialty consultation. It matters as telehealth and store-and-forward services expand and payers consider sustainable coverage pathways.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise outlook on clinical context for asynchronous image review, typical sites of service, and the role of this code within value-based and pilot payment models. The publication summarizes available benchmarks where present and highlights policy-oriented considerations, including the code’s restriction to Medicare-approved CMMI models and the implication for broader payer adoption. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G9870 describes 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 represents remote review and interpretation of patient-captured or clinician-submitted still images or image series when the clinician evaluates dermatologic lesions or ophthalmologic findings without a real-time interaction.
Service type: Asynchronous telehealth image review and interpretation, extended duration (more than 20 minutes).
Typical site of service: Remote/clinician office or other outpatient setting where images are received and reviewed; patient location remote from the clinician (e.g., home or other non-clinical site).
Clinical & Coding Specifications
Clinical Context
A 72-year-old Medicare beneficiary enrolled in a Medicare-approved CMMI model submits dermatologic images of a suspicious skin lesion captured at a primary care clinic and asynchronously transmitted to a dermatology practice. The patient has multiple chronic conditions and limited mobility, so primary care staff obtain high-resolution photos and relevant history, then forward the secure images to a dermatologist participating in the model. The dermatologist receives the asynchronous images, reviews and analyzes them for more than 20 minutes, documents findings, and returns a diagnostic impression with recommended next steps (for example, in-person biopsy, telemedicine visit, or reassurance with monitoring). The workflow includes image receipt, clinical triage, electronic charting, and secure patient communication of results. Typical site of service is outpatient ambulatory clinics or physician offices that capture and transmit images, and the remote specialist’s office where analysis occurs. The service is specific to dermatologic and ophthalmologic image evaluations under the CMMI model and is reported when the remote analysis time exceeds 20 minutes.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default or no modifier | Use when no modifier applies to the service |
11 |