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See a sample rate comparisonHCPCS G2116 Fee Schedule
HCPCS G2116 is classified under Procedures / Professional Services, in the Functional Status subgroup.
Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Functional Status |
| Complexity Level | Low |
National average reimbursement for HCPCS G2116 by major payers:
$71.24
BCBS / Anthem
$N/A
UnitedHealthcare
$0.01
Aetna
$0.00
Cigna
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HCPCS G2116
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See a sample payer proposalHCPCS G2116 vs. Other Functional Status Codes
The table lists codes related to G2116. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| G2115-HCPCS | Low | Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and a dispensed medication for dementia during the measurement period or the year prior to the measurement period |
| G2116-HCPCS | Low | Patients 66 - 80 years of age with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period |
| G2118-HCPCS | Low | Patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G2116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G2116 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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