Summary & Overview
HCPCS G9984: Remote In-Home Evaluation and Management Visit
HCPCS Level II code G9984 designates a remote in-home evaluation and management visit for established patients within a Medicare-approved BPCI Advanced episode of care. The code captures a synchronous audio-video E/M encounter of about 15 minutes that requires at least two of three elements: an expanded problem focused history, an expanded problem focused examination, or low-complexity medical decision making. It is designed to support in-home telehealth interactions that include counseling and coordination of care and typically addresses problems of low to moderate severity.
This publication covers national relevance of G9984 across major payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and service characteristics, payer coverage considerations, common modifiers associated with telehealth and post-acute care billing, and practical benchmarks where available. The analysis highlights how G9984 fits within bundled payment models and in-home telehealth service lines, and summarizes policy and coding implications that affect billing, documentation, and program eligibility. Data not available in the input is noted where applicable.
Clinical & Coding Specifications
Clinical Context
A 68-year-old established Medicare beneficiary recovering at home after a recent elective total knee arthroplasty enrolled in the Bundled Payments for Care Improvement Advanced (BPCI Advanced) episode of care requests a scheduled remote in-home evaluation via two-way audio and video. The orthopaedic surgeon or an advanced practice clinician conducts the visit using a secure telehealth platform. The clinician documents an expanded problem focused history addressing postoperative pain control, wound status, functional mobility, and anticoagulation adherence; performs an expanded problem focused virtual examination observing wound appearance, range of motion, and gait with caregiver assistance; and completes medical decision making of low complexity regarding pain medication adjustments and outpatient physical therapy escalation. Counseling and care coordination occur with the physical therapy team and home health agency. The visit lasts approximately 15 minutes in real time and is billed using G9984 for the 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 | Use when service is delivered via live audiovisual telehealth platform. |