HCPCS G9490 Fee Schedule

Last Verified: January 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.

CMS innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code

Key Fact	Detail
Service Type	• Procedures / Professional Services • Additional Assorted Quality Measures
Complexity Level	Low

National average reimbursement for HCPCS G9490 by major payers:

$64.71

$55.69

$44.78

$51.51

Preview provider-level rates for...

For billing codeHCPCS G9490

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 G9490
United	G9490	$61.58	1497064679 - JENKINS COUNTY HOSPITAL LLC, OPTIM MEDICAL CENTER - JENKINS	273100894	GA	Critical Access Hospital (282NC0060X)
United	G9490	$90.70	1063741163 - AZTEC URGENT CARE, LLC	271495988 - (NM) AZTEC URGENT CARE LLC	NM	Urgent Care Clinic/Center (261QU0200X)
United	G9490	$94.50	1033165865 - DAVID EPSTEIN	591212948 - (FL) RADIOLOGY ASSOCIATES OF CLEARWATER, P.A.	FL	Diagnostic Radiology Physician (2085R0202X)
United	G9490	$53.22	1942682653 - RABIA JAMY	752654757 - TEXAS NEUROLOGY, P. A.	TX	Neurology Physician (2084N0400X)
United	G9490	$59.09	1790942381 - TATTNALL HOSPITAL COMPANY, LLC, OPTIM MEDICAL CENTER - TATTNALL	300466706	GA	Critical Access Hospital (282NC0060X)
United	G9490	$94.50	1033165865 - DAVID EPSTEIN	591212948 - (FL) RADIOLOGY ASSOCIATES OF CLEARWATER, P.A.	FL	Diagnostic Radiology Physician (2085R0202X)
United	G9490	$50.29	1235162751 - TEXAS RADIOLOGY ASSOCIATES LLP	751459885 - TEXAS RADIOLOGY ASSOCIATES, LLP	TX	Diagnostic Radiology Physician (2085R0202X)
United	G9490	$35.95	1548859895 - ALICIA ENCINAS	300394179 - (AZ) MIGUEL A ARENAS MD PC	CA	Family Nurse Practitioner (363LF0000X)
United	G9490	$58.88	1487684122 - UNION COUNTY HOSPITAL AUTHORITY, UNION GENERAL HOSPITAL	586025393 - (GA) UNION COUNTY HOSPITAL AUTHORITY	GA	General Acute Care Hospital (282N00000X)
United	G9490	$61.58	1225031750 - JASPER HEALTH SERVICES, INC., JASPER MEMORIAL HOSPITAL	582510435 - (GA) JASPER HEALTH SERVICES INC	GA	Critical Access Hospital (282NC0060X)
United	G9490	$82.20	1306890942 - BROOKS COUNTY HOSPITAL	586002830	GA	Critical Access Hospital (282NC0060X)
United	G9490	$54.75	1063741163 - AZTEC URGENT CARE, LLC	271495988 - (NM) AZTEC URGENT CARE LLC	NM	Urgent Care Clinic/Center (261QU0200X)
United	G9490	$55.68	1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC	571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC	SC	Diagnostic Radiology Physician (2085R0202X)
United	G9490	$50.29	1083990717 - TEXAS RADIOLOGY ASSOCIATES LLP	751459885 - TEXAS RADIOLOGY ASSOCIATES, LLP	HI	Diagnostic Radiology Physician (2085R0202X)
United	G9490	$109.35	1073502985 - CHU CHEN	42484572	MA	Pediatrics Physician (208000000X)
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 G9490 vs. Other Additional Assorted Quality Measures Codes

The HCPCS G9490 code is part of the Procedures / Professional Services services used for Additional Assorted Quality Measures. 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 G9490 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
G9489-HCPCS	Low	Remote in-home visit for the evaluation and management of an established patient for use only in a medicare-approved cms innovation center demonstration project, which requires at least 2 of the following 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity, furnished in real time using interactive audio and video technology. counseling and coordination of care with other physicians, other qualified health care professionals or agencies are provided consistent with the nature of the problem(s) and the needs of the patient or the family or both. usually, the presenting problem(s) are of moderate to high severity. typically, 40 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology
G9490-HCPCS	Low	CMS innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services. (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code
G9497-HCPCS	Low	Received instruction from the anesthesiologist or proxy prior to the day of surgery to abstain from smoking on the day of surgery

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G9490. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the G9490 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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