Question 1

What is HCPCS code G9490?

Accepted Answer

HCPCS code G9490 is "Cmmi mod home visit". Cms innovation center models, home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services.  (for use only in medicare-approved cms innovation center models); may not be billed for a 30 day period covered by a transitional care management code

Question 2

What category is G9490 in?

Accepted Answer

G9490 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9490?

Accepted Answer

Use G9490 when billing for cmmi mod home visit. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G9490 covered by Medicare?

Accepted Answer

Coverage for G9490 (Cmmi mod home visit) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G9490?

Accepted Answer

Documentation for G9490 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).