HCPCS G9980 Fee Schedule
Last Updated: August 2025
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Procedures / Professional Services • Remote In-House Evaluation And Management Assessment |
| Common Place of Service | |
| Common Modifiers | |
| Complexity Level | Moderate |
National average reimbursement for HCPCS G9980 by major payers:
$116.70
$97.05
$72.90
$112.21
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Related Codes
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G9980. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G9980 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.
HCPCS G9980 vs. Other Remote In-House Evaluation And Management Assessment Codes
The HCPCS G9980 code is part of the Procedures / Professional Services services used for Remote In-House Evaluation And Management Assessment. 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 G9980 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.
| HCPCS Code | Complexity Level | Description |
|---|---|---|
| G9979 | Low | Remote in-home visit for the evaluation and management of a new patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires these 3 key components:
An expanded problem focused history;
An expanded problem focused examination;
Straightforward medical decision making, 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 low to moderate severity. Typically, 20 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. |
| G9980 | Low | Remote in-home visit for the evaluation and management of a new patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires these 3 key components:
A detailed history;
A detailed examination;
Medical decision making of low 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 severity. Typically, 30 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. |
| G9981 | Low | Remote in-home visit for the evaluation and management of a new patient for use only in a Medicare-approved Bundled Payments for Care Improvement Advanced (BPCI Advanced) model episode of care, which requires these 3 key components:
A comprehensive history;
A comprehensive examination;
Medical decision making of moderate 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, 45 minutes are spent with the patient or family or both via real time, audio and video intercommunications technology. |
See what providers are getting paid in 2025 for G9980:
HCPCS G9980 Fee Schedule & Reimbursement Rates
The HCPCS G9980 fee schedule varies by payer type. Below are Medicare rates for 2025 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. BCBS National Rate | More Info |
|---|---|---|---|
| G9979 | $72.23 | $77.19 | |
| G9980 | $105.52 | $116.70 | |
| G9981 | $161.44 | $189.22 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
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