G9982 Remote In‑Home E/M (HCPCS) Reimbursement | OpenPayer

Summary & Overview

HCPCS G9982: Remote In-Home New Patient Evaluation and Management

HCPCS Level II code G9982 designates a remote in-home evaluation and management (E/M) visit for a new patient using real-time audio and video. The service mandates a comprehensive history and examination plus high-complexity medical decision making, typically lasting about 60 minutes, and includes counseling and care coordination. This code is important nationally as telehealth and bundled-payment models evolve, particularly within Medicare’s BPCI Advanced and other alternative payment arrangements that emphasize remote, high-acuity management in the patient’s home. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn the clinical scope and operational expectations tied to G9982, payer coverage considerations across major national payers, typical service settings and time requirements, and where this code fits in bundled payment and telehealth care pathways. The summary covers benchmark and policy-relevant context, payment model implications, and billing considerations relevant to providers and health plan administrators. Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific rates.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9982HCPCS Level IItelehealth

Clinical & Coding Specifications

Clinical Context

A 72-year-old Medicare beneficiary enrolled in a BPCI Advanced episode following recent total knee arthroplasty develops new onset increasing knee pain, swelling, and limited mobility two weeks after discharge. The orthopedic surgeon elects to perform a remote in-home evaluation and management visit using interactive audio-video technology because the patient has mobility limitations and lives in a rural area. The clinician (orthopedic surgeon or advanced practice provider) completes a comprehensive history (review of surgical course, infection symptoms, pain control, functional status, medication reconciliation), a comprehensive real-time visual examination of the operative site and gait as feasible via video, and medical decision making of high complexity to assess for postoperative infection, wound complication, or need for urgent in-person care. Counseling and coordination of care are provided with home health nursing and the surgical team. The encounter is delivered in real time using secure, interactive audio and video, and lasts approximately 60 minutes with documentation supporting time and the three required components for use only within a Medicare-approved BPCI Advanced episode of care.

Coding Specifications

Modifier	Description	When to Use
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Append when service furnished via interactive audio-video telehealth in payors that recognize modifier `95`.

HCPCS G8711: Prescribed Antibiotic on or Within 3 Days After Episode Date

HCPCS-G8785-BLOOD-PRESSURE-NOT-DOCUMENTED

HCPCS Level II G8785: Blood Pressure Reading Not Documented

HCPCS-G9787-PATIENT-ALIVE-MEASUREMENT-YEAR-STATUS

HCPCS G9787: Patient Alive as of Measurement Year End

HCPCS-G9480-MEDICARE-CARE-CHOICES-MODEL-ENROLLMENT

HCPCS G9480: Admission to Medicare Care Choices Model (MCCM)

HCPCS-G8943-LDL-C-RESULT-MISSING-WITHIN-12-MONTHS

HCPCS G8943: LDL-C Result Not Present or Not Within 12 Months

HCPCS-G8985-CARRYING-MOVING-HANDLING-OBJECTS-FUNCTIONAL-STATUS

HCPCS G8985: Carrying, Moving and Handling Objects, Projected Goal Status

HCPCS-G9896-ADT-NOT-USED-WITH-EXTERNAL-BEAM-RADIOTHERAPY-PROSTATE

HCPCS G9896: Documentation for Omission of ADT with Prostate External Beam Radiotherapy

HCPCS-G8866-PNEUMOCOCCAL-VACCINE-DOCUMENTATION-REFUSAL

HCPCS G8866: Documentation of Reason for Not Receiving Pneumococcal Vaccine

HCPCS-G2075-MEDICATION-ASSISTED-TREATMENT-WEEKLY-BUNDLE-OTP

HCPCS G2075: Medication Assisted Treatment Weekly Bundle

HCPCS-G9509-DEPRESSION-REMISSION-12-MONTHS-PHQ9

HCPCS G9509: Depression Remission at 12 Months

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`2080S00000X`	Orthopaedic Surgery	Orthopedic surgeons commonly manage post-operative BPCI Advanced episodes and perform comprehensive remote E/M evaluations.
`363L00000X`	Physical Medicine & Rehabilitation	PM&R physicians manage functional status and rehabilitation needs in post-acute episodes via telehealth.
`207Q00000X`	Family Medicine	Primary care physicians coordinate ongoing care, medication management, and triage for complications.
`208000000X`	General Surgery	General surgeons may provide postoperative remote evaluations for applicable surgical episodes.
`367A00000X`	Nurse Practitioner	Advanced practice providers frequently deliver telehealth E/M visits under supervision or independently per state rules.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`T84.0XXA`	Infection and inflammatory reaction due to internal joint prosthesis, initial encounter	Relevant for suspected prosthetic joint infection after recent arthroplasty assessed via remote exam and history.
`M17.11`	Unilateral primary osteoarthritis, right knee	Common underlying diagnosis leading to knee arthroplasty; relevant to post-operative episode management.
`M17.12`	Unilateral primary osteoarthritis, left knee	As above for the contralateral knee when applicable.
`M25.561`	Pain in right knee	Symptom commonly driving a remote postoperative evaluation.
`M25.562`	Pain in left knee	Symptom commonly driving a remote postoperative evaluation.
`Z48.89`	Aftercare following other surgery	General aftercare code applicable during a post-surgical BPCI Advanced episode for follow-up care.
`Z96.651`	Presence of right artificial knee joint	Documented prosthesis status relevant to post-arthroplasty evaluation.
`Z96.652`	Presence of left artificial knee joint	Documented prosthesis status relevant to post-arthroplasty evaluation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99205`	Office or other outpatient visit for the evaluation and management of a new patient, typically 60–74 minutes of total time on the date of the encounter	Clinically similar in intensity and time; may be used for in-person new patient evaluations when an in-person visit replaces the remote BPCI Advanced visit.
`99223`	Initial hospital care, typically 70 minutes per day, for evaluation and management of a patient	Used when the patient requires inpatient admission after remote assessment; documents comparable high-complexity medical decision making.
`99441`	Telephone evaluation and management service by a physician or other qualified health care professional, 21-30 minutes of medical discussion	May be used adjunctively for shorter follow-up communications but does not meet the audiovisual requirement of the BPCI Advanced remote in-home visit.
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the physician	May be used when remote monitoring data are incorporated into the high-complexity decision making for inpatient/outpatient episode management.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Example of adjunct counseling services that could be provided during coordinated care but billed separately if criteria met.

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