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See a sample rate comparisonHCPCS G0085 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.
Extensive (75 minutes) care management home visit for an existing 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 | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for G0085 |
National average reimbursement for HCPCS G0085 by major payers:
$285.93
$277.09
$213.82
$222.65
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HCPCS G0085
5 of 25 sample ratesHigher to lower in this preview
Arthur M. Blank Hospital, Inc., Arthur M. Blank Hospital
Childrens Healthcare Of Atlanta Inc
$753.15Published rateEmory Healthcare
Emory University
$434.76Published rateJulie Webster
Carolina Radiology Associates, LLC
$288.89Published rateTexas Radiology Associates LLP
Texas Radiology Associates, LLP
$245.91Published rateCindy Chang
Miguel A Arenas Md PC
$173.88Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G0085 vs. Other Home Care Management Services Codes
The HCPCS G0085 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 G0085 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 |
|---|---|---|
| G0084-HCPCS | Moderate | Comprehensive (60 minutes) care management home visit for an existing 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) |
| G0085-HCPCS | Moderate | Extensive (75 minutes) care management home visit for an existing 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) |
| G0086-HCPCS | Low | Limited (30 minutes) care management home care plan oversight. 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 G0085. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G0085 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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