G9485 HCPCS code: Remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9485 is the HCPCS Level II code for remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. In 2024 Medicare paid an average of $61.33 per service for G9485 across 33 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 2 per day on outpatient hospital claims. Medicare volume fell 55% from 2022 to 2024 (73 to 33 services). In 2024, about 25 clinicians billed Medicare for G9485 for 33 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Z2 |
| Added | 2016-04-01 |
| Last action effective | 2018-01-01 |
Who bills G9485 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 25 |
| Medicare beneficiaries | 33 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G9485, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 73 | 73 | $120.45 | $90.91 |
| 2023 | 90 | 89 | $113.36 | $89.01 |
| 2024 | 33 | 33 | $109.49 | $61.33 |
States with the most G9485 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Michigan | 31 | $59.53 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Nature of Service/Procedure |
| practitioner claims | 1 | Nature of Service/Procedure |
What changed for G9485
- 2016-04-01: G9485 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 G9485?
G9485 is the HCPCS Level II code for remote in-home visit for the evaluation and management of a new patient for use only in a medicare-approved cms innovation center demonstration project, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 60 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. Short descriptor: "Remote e/m new pt 60mins".
How much does Medicare pay for G9485?
In 2024, the average Medicare payment was $61.33 per service (average allowed $109.49).
Does Medicare cover G9485?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of G9485 can be billed per day?
2 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related G94 codes
- G9400 — Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons
- G9401 — No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment
- G9402 — Patient received follow-up within 30 days after discharge
- G9403 — Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up)
- G9404 — Patient did not receive follow-up within 30 days after discharge
- G9405 — Patient received follow-up within 7 days after discharge
- G9406 — Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up)
- G9407 — Patient did not receive follow-up within 7 days after discharge
- G9408 — Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days
- G9409 — Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days
- G9410 — Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
- G9411 — Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
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Next steps
- Run a reimbursement report for a device billed under G9485
- Watch G9485 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G9485
Sources: CMS HCPCS Level II release October 2025; 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.