HCPCS G9979: Remote In-Home New Patient Evaluation via Video E/M

HCPCS Level II code G9979 designates a remote in-home evaluation and management (E/M) visit for a new patient when delivered within a Medicare-approved BPCI Advanced episode of care. The code specifies a synchronous audio-video encounter that includes an expanded problem-focused history and examination with straightforward medical decision making, typically lasting about 20 minutes. As bundled payment models expand, codes like G9979 matter because they clarify allowable telehealth services embedded in episodic care, enabling consistent documentation and billing for remote E/M services tied to bundled payment episodes.

Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical service and setting, which payers recognize these services, and what to expect in claims processing for bundled-model telehealth visits. The briefing also outlines common modifiers and implementation considerations relevant to telehealth in bundled payment contexts.

This publication delivers practical benchmarks and policy context for clinicians and billing professionals operating within bundled payment programs, clarifies the service definition and site-of-service expectations, and summarizes payer coverage patterns and coding considerations for remote in-home new-patient E/M visits under BPCI Advanced.

Clinical Context

A 72-year-old Medicare beneficiary enrolled in a Bundled Payments for Care Improvement Advanced (BPCI Advanced) episode of care following hospital discharge for congestive heart failure is assessed via a real-time audio-video in-home telemedicine visit. The home health nurse or physician uses interactive video to conduct an expanded problem-focused history (reviewing current symptoms, medication adherence, weight changes, and home oxygen use), an expanded problem-focused examination (visual inspection for peripheral edema, respiratory effort, jugular venous distention, and assessment of home environment and support), and documents straightforward medical decision making. Counseling and coordination of care occur with the patient’s cardiologist, primary care physician, and home health agency to adjust diuretics and arrange outpatient testing. The encounter typically lasts about 20 minutes, addresses low-to-moderate severity problems (e.g., fluid overload, medication questions), and is billed using G9979 for a new patient remote in-home evaluation and management within a Medicare-approved BPCI Advanced episode.

Coding Specifications

Modifier	Description	When to Use
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when the service was delivered live via audio-video technology.

Billing Code Overview

HCPCS Level II code G9979 describes a remote in-home evaluation and management visit for a new patient when furnished as part of a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care. The service requires three key components: an expanded problem-focused history, an expanded problem-focused examination, and straightforward medical decision making. The visit is delivered in real time using interactive audio and video technology, with counseling and coordination of care provided as needed. The presenting problem(s) are usually of low to moderate severity, and the typical visit length is approximately 20 minutes via synchronous audio-video communication.

Service Type: Telehealth — synchronous video evaluation and management (E/M) for a new patient within a BPCI Advanced episode.

Typical Site of Service: Patient's home (remote in-home setting) via interactive audio and video technology.

Taxonomy Code	Specialty	Notes
`207RL0500X`	Cardiology	Cardiologists frequently coordinate BPCI Advanced post-discharge tele-evaluations for cardiac patients
`207Q00000X`	Internal Medicine	Hospitalists and internists provide medical management and remote E/M services in home settings
`243Z00000X`	Family Medicine	Family physicians perform comprehensive in-home telehealth evaluations for complex chronic care
`163W00000X`	Nurse Practitioner	NPs commonly deliver telehealth E/M in home settings under physician collaboration
`363A00000X`	Home Health Agency	Home health clinicians coordinate visits and remote assessments within bundled episodes

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.33`	Acute on chronic diastolic (congestive) heart failure	Common reason for post-discharge in-home tele-evaluation to assess volume status and medication needs.
`I50.23`	Chronic systolic (congestive) heart failure with acute exacerbation	Frequently managed during BPCI Advanced cardiac episodes via remote monitoring and adjustments.
`J44.1`	Chronic obstructive pulmonary disease with acute exacerbation	Respiratory comorbidity that may prompt home tele-evaluation for breathing status and oxygen use.
`E11.65`	Type 2 diabetes mellitus with hyperglycemia	Common chronic condition requiring medication reconciliation and coordination during post-discharge visits.
`Z74.01`	Bed confinement status	Social determinant or functional status often assessed during in-home evaluations to plan home services.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99441`	Phone evaluation and management service by a physician, 5-10 minutes of medical discussion	May be used for brief follow-up via audio-only when video is not available, complementary to `G9979` when converting to shorter telephonic contacts.
`99421`	Online digital E/M service, typically 5-10 minutes of cumulative time over 7 days	Used for non–real-time patient-initiated digital communications that supplement the real-time telemedicine visit.
`99406`	Smoking and tobacco use cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Can be provided during the telehealth visit if counseling for tobacco cessation is part of the care plan.
`99354`	Prolonged service in the office or other outpatient setting, first hour (direct patient contact beyond usual service)	May be reported when the telemedicine encounter is prolonged beyond typical time and documentation supports prolonged services.
`99490`	Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional per calendar month	Often provided concurrently in bundled care episodes to manage chronic conditions between `G9979` encounters.

OpenPayer

Summary & Overview