HCPCS G9090 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Procedures / Professional Services • Medicare Demonstration Projects |
| Complexity Level | Low |
National average reimbursement for HCPCS G9090 by major payers:
$61.06
$9.62
$0.39
$7.58
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS G9090 | ||||||
United | G9090 | $13.94 | 1427189927 - DEVON DANEY | 271495988 - (NM) AZTEC URGENT CARE LLC | CO | Family Medicine Physician (207Q00000X) |
United | G9090 | $7.88 | 1952557498 - JEREMY KELLEY | 451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINE | AL | Family Nurse Practitioner (363LF0000X) |
United | G9090 | $8.43 | 1730419904 - TEXAS RADIOLOGY ASSOCIATES LLP | 751459885 - TEXAS RADIOLOGY ASSOCIATES, LLP | TX | Diagnostic Radiology Physician (2085R0202X) |
United | G9090 | $7.65 | 1790715381 - NORTHSIDE HOSPITAL, INC., NORTHSIDE HOSPITAL DULUTH | 582002413 | GA | General Acute Care Hospital (282N00000X) |
United | G9090 | $7.65 | 1356860621 - CHI MEMORIAL HOSPITAL | 822748395 - CHI MEMORIAL HOSPITAL - GEORGIA | GA | General Acute Care Hospital (282N00000X) |
United | G9090 | $11.30 | 1063490845 - KEVIN SCHLESSEL | 311425166 | OH | Rheumatology Physician (207RR0500X) |
United | G9090 | $10.52 | 1396769964 - JULIE WEBSTER | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Body Imaging Physician (2085B0100X) |
United | G9090 | $17.28 | 1992799050 - GRADY MEMORIAL HOSPITAL CORPORATION, GRADY HEALTH SYSTEMS | 581537752 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | G9090 | $6.30 | 1255478004 - CHRISTOPHER RAIO | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | NY | Emergency Medicine Physician (207P00000X) |
United | G9090 | $10.72 | 1225339898 - SCREVEN COUNTY HOSPITAL, LLC, OPTIM MEDICAL CENTER - SCREVEN | 273100946 | GA | Critical Access Hospital (282NC0060X) |
United | G9090 | $20.31 | 1396923710 - EMORY UNIVERSITY HOSPITAL | 582030692 - EMORY UNIVERSITY | GA | General Acute Care Hospital (282N00000X) |
United | G9090 | $6.15 | 1548859895 - ALICIA ENCINAS | 300394179 - (AZ) MIGUEL A ARENAS MD PC | CA | Family Nurse Practitioner (363LF0000X) |
United | G9090 | $19.98 | 1306136551 - UJUKA ILOABUCHI | 474870066 - (GA) GWINNETT OBGYN ASSOCIATES OF GEORGIA LLC | GA | Women's Hospital (282NW0100X) |
United | G9090 | $13.15 | 1033320049 - ANN STECK | 10877201 | OH | Family Medicine Physician (207Q00000X) |
United | G9090 | $10.52 | 1396769964 - JULIE WEBSTER | 853861695 - MUSC COMMUNITY PHYSICIANS | SC | Body Imaging Physician (2085B0100X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS G9090 vs. Other Medicare Demonstration Projects Codes
The HCPCS G9090 code is part of the Procedures / Professional Services services used for Medicare Demonstration Projects. 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 G9090 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 |
|---|---|---|
| G9089-HCPCS | Low | Oncology; disease status; colon cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease unknown, staging in progress, or not listed (for use in a Medicare-approved demonstration project) |
| G9090-HCPCS | Low | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as T1-2, N0, M0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a Medicare-approved demonstration project) |
| G9091-HCPCS | Low | Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as T3, N0, M0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a Medicare-approved demonstration project) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G9090. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G9090 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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