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See a sample rate comparisonHCPCS G9861 Fee Schedule
HCPCS G9861 is classified under Procedures / Professional Services, in the Additional Assorted Quality Measures subgroup.
Patient spent greater than or equal to three days in hospice care
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Additional Assorted Quality Measures |
| Complexity Level | Low |
National average reimbursement for HCPCS G9861 by major payers:
$71.17
BCBS / Anthem
$N/A
UnitedHealthcare
$0.01
Aetna
$1.16
Cigna
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HCPCS G9861
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G9861 vs. Other Additional Assorted Quality Measures Codes
The table lists codes related to G9861. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| G9860-HCPCS | Low | Patient spent less than three days in hospice care |
| G9861-HCPCS | Low | Patient spent greater than or equal to three days in hospice care |
| G9862-HCPCS | Low | Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G9861. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G9861 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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