G9004 HCPCS code: Coordinated care fee, risk adjusted low, initial
G9004 is the HCPCS Level II code for coordinated care fee, risk adjusted low, initial. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Y2 |
| Added | 2000-10-01 |
| Last action effective | 2000-10-01 |
What changed for G9004
- 2000-10-01: G9004 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G9004?
G9004 is the HCPCS Level II code for coordinated care fee, risk adjusted low, initial. Short descriptor: "Mccd, risk adj lo, initial".
Does Medicare cover G9004?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Related G90 codes
- G9001 — Coordinated care fee, initial rate
- G9002 — Coordinated care fee, maintenance rate
- G9003 — Coordinated care fee, risk adjusted high, initial
- G9005 — Coordinated care fee, risk adjusted maintenance
- G9006 — Coordinated care fee, home monitoring
- G9007 — Coordinated care fee, scheduled team conference
- G9008 — Coordinated care fee, physician coordinated care oversight services
- G9009 — Coordinated care fee, risk adjusted maintenance, level 3
- G9010 — Coordinated care fee, risk adjusted maintenance, level 4
- G9011 — Coordinated care fee, risk adjusted maintenance, level 5
- G9012 — Other specified case management service not elsewhere classified
- G9013 — Esrd demo basic bundle level i
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Next steps
- Run a reimbursement report for a device billed under G9004
- Watch G9004 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G9004
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.