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See a sample rate comparisonHCPCS G9938 Fee Schedule
HCPCS G9938 is classified under Procedures / Professional Services, in the Geriatric Care Management and Other Services subgroup.
Patients aged 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Geriatric Care Management and Other Services |
| Complexity Level | Low |
National average reimbursement for HCPCS G9938 by major payers:
$71.53
BCBS / Anthem
$N/A
UnitedHealthcare
$0.01
Aetna
$1.16
Cigna
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HCPCS G9938
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See a sample payer proposalHCPCS G9938 vs. Other Geriatric Care Management and Other Services Codes
The table lists codes related to G9938. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| G9931-HCPCS | Low | Documentation of cha2ds2-vasc risk score of 0 or 1 for men; or 0, 1, or 2 for women |
| G9938-HCPCS | Low | Patients aged 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period |
| G9939-HCPCS | Low | Pathologists/dermatopathologists is the same clinician who performed the biopsy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G9938. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G9938 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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