G9011 — Coordinated care fee, risk adjusted maintenance, level 5
G9011 is a HCPCS Level II code for coordinated care fee, risk adjusted maintenance, level 5. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for G9011
- Long descriptor
- Coordinated care fee, risk adjusted maintenance, level 5
- Short descriptor
- Mccd, risk adj, level 5
- Added
- October 1, 2001
- BETOS
- Y2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to G9011
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9011 is not quite right, the correct code is very often within a few positions of it.
- G9003Coordinated care fee, risk adjusted high, initial
- G9004Coordinated care fee, risk adjusted low, initial
- G9005Coordinated care fee, risk adjusted maintenance
- G9006Coordinated care fee, home monitoring
- G9007Coordinated care fee, scheduled team conference
- G9008Coordinated care fee, physician coordinated care oversight services
- G9009Coordinated care fee, risk adjusted maintenance, level 3
- G9010Coordinated care fee, risk adjusted maintenance, level 4
- G9012Other specified case management service not elsewhere classified
- G9013Esrd demo basic bundle level i
- G9014Esrd demo expanded bundle including venous access and related services
- G9016Smoking cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session (6-10 minutes) [demo project code only]
- G9017Amantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)terminated
- G9018Zanamivir, inhalation powder, administered through inhaler, per 10 mg (for use in a medicare-approved demonstration project)terminated
- G9019Oseltamivir phosphate, oral, per 75 mg (for use in a medicare-approved demonstration project)terminated
- G9020Rimantadine hydrochloride, oral, per 100 mg (for use in a medicare-approved demonstration project)terminated
Questions about G9011
What is HCPCS code G9011?
G9011 is a HCPCS Level II code for coordinated care fee, risk adjusted maintenance, level 5. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9011?
The CMS HCPCS file marks G9011 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is G9011 paid under the physician fee schedule?
G9011 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.