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See a sample rate comparisonHCPCS G9685 Fee Schedule
Medicare rates as of October 2026
HCPCS G9685 is classified under Procedures / Professional Services, in the Additional Assorted Quality Measures subgroup.
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 |
| Medicare Fee Schedule | $156.65 national non-facility rate (2026) · View Medicare rates for G9685 |
| Medicaid Fee Schedule | $99.90 median of the 3 states in the free preview · View Medicaid rates for G9685 |
National average reimbursement for HCPCS G9685 by major payers:
$249.88
BCBS / Anthem
$252.51
UnitedHealthcare
$184.39
Aetna
$196.29
Cigna
Compare published rates across providers.
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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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Payer Contract Negotiation
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See a sample payer proposalHCPCS G9685 vs. Other Additional Assorted Quality Measures Codes
The table lists codes related to G9685. Select one to see its fee schedule.
| 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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