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See a sample rate comparisonHCPCS G8430 Fee Schedule
HCPCS G8430 is classified under Procedures / Professional Services, in the Additional Quality Measures subgroup.
Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient's current medications list (e.g., patient is in an acute health crisis where time is of the essence and delay of treatment would jeopardize the patient's health status)
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Additional Quality Measures |
| Complexity Level | Low |
National average reimbursement for HCPCS G8430 by major payers:
$60.00
BCBS / Anthem
$37.81
UnitedHealthcare
$0.03
Aetna
$1.16
Cigna
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HCPCS G8430
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G8430 vs. Other Additional Quality Measures Codes
The table lists codes related to G8430. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| G8428-HCPCS | Low | Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
| G8430-HCPCS | Low | Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient's current medications list (e.g., patient is in an acute health crisis where time is of the essence and delay of treatment would jeopardize the patient's health status) |
| G8431-HCPCS | Low | Screening for depression is documented as being positive and a follow-up plan is documented |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G8430. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G8430 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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