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See a sample rate comparisonHCPCS G0078 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility)
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Home Care Management Services |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for G0078 |
National average reimbursement for HCPCS G0078 by major payers:
$172.22
$162.58
$124.49
$129.49
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HCPCS G0078
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
$302.32Published rateBradley Smith
Emergeortho, P.A.
$220.75Published rateAtlanta Vamc
$172.42Published rateJulie Webster
Musc Community Physicians
$153.35Published rateGeorge Hemstreet
Bama Heart Doc, PC Dba Alabama Heart & Vascular Medicine
$105.56Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G0078 vs. Other Home Care Management Services Codes
The HCPCS G0078 code is part of the Procedures / Professional Services services used for Home Care Management Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS G0078 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| G0077-HCPCS | Low | Limited (30 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0078-HCPCS | Low | Moderate (45 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
| G0079-HCPCS | Moderate | Comprehensive (60 minutes) care management home visit for a new patient. for use only in a medicare-approved cmmi model. (services must be furnished within a beneficiary's home, domiciliary, rest home, assisted living and/or nursing facility) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G0078. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0078 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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