G9685 HCPCS code: Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project
G9685 is the HCPCS Level II code for physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 1 per day on outpatient hospital claims.
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 | 2016-10-01 |
| Last action effective | 2019-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Nature of Service/Procedure |
| practitioner claims | 1 | Nature of Service/Procedure |
What changed for G9685
- 2016-10-01: G9685 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 G9685?
G9685 is the HCPCS Level II code for physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project. Short descriptor: "Acute nursing facility care".
Does Medicare cover G9685?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of G9685 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related G96 codes
- G9600 — Symptomatic aaas that required urgent/emergent (non-elective) repair
- G9601 — Patient discharge to home no later than post-operative day #7
- G9602 — Patient not discharged to home by post-operative day #7
- G9603 — Patient survey score improved from baseline following treatment
- G9604 — Patient survey results not available
- G9605 — Patient survey score did not improve from baseline following treatment
- G9606 — Intraoperative cystoscopy performed to evaluate for lower tract injury
- G9607 — Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death
- G9608 — Intraoperative cystoscopy not performed to evaluate for lower tract injury
- G9609 — Documentation of an order for anti-platelet agents
- G9610 — Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents
- G9611 — Order for anti-platelet agents was not documented in the patient's record, reason not given
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Next steps
- Run a reimbursement report for a device billed under G9685
- Watch G9685 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G9685
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.