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See a sample rate comparisonHCPCS G8854 Fee Schedule
HCPCS G8854 is classified under Procedures / Professional Services, in the More Quality Measures subgroup.
Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy)
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services More Quality Measures |
| Complexity Level | Low |
National average reimbursement for HCPCS G8854 by major payers:
$63.82
BCBS / Anthem
$54.00
UnitedHealthcare
$0.01
Aetna
$1.16
Cigna
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HCPCS G8854
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G8854 vs. Other More Quality Measures Codes
The table lists codes related to G8854. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| G8854-HCPCS | Low | Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy) |
| G8855-HCPCS | Low | Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G8854. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G8854 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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