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See a sample rate comparisonHCPCS G9685 Fee Schedule
Last Verified: September 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.
Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Additional Assorted Quality Measures |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for G9685 |
National average reimbursement for HCPCS G9685 by major payers:
$249.88
$252.51
$184.39
$196.29
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HCPCS G9685
5 of 25 sample ratesHigher to lower in this preview
Arthur M. Blank Hospital, Inc., Arthur M. Blank Hospital
Childrens Healthcare Of Atlanta Inc
$682.78Published rateSharron Acosta M.D.P.A.
Sharron Acosta, M.D., P.A.
$355.57Published rateHospital Authority Of Candler County, Candler County Hospital
$288.22Published rateTexas Radiology Associates LLP
Texas Radiology Associates, LLP
$227.30Published rateThe Medical Center Inc, Piedmont Columbus Regional Midtown
The Medical Center Inc
$193.47Published rate
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See a sample payer proposalHCPCS G9685 vs. Other Additional Assorted Quality Measures Codes
The HCPCS G9685 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 G9685 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 |
|---|---|---|
| G9684-HCPCS | Low | This code is for the onsite acute care treatment of a nursing facility resident for a UTI; may only be billed once per day per beneficiary |
| G9685-HCPCS | Moderate | Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project |
| G9687-HCPCS | Low | Hospice services provided to patient any time 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 G9685. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G9685 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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