G9685 — Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project
G9685 is a HCPCS Level II code for physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
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 statusA
Active code. Paid separately under the physician fee schedule.
- Work RVU
- 3.50
- PE (non-facility)
- 0.90
- PE (facility)
- 0.90
- Malpractice RVU
- 0.29
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of G9685 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1 unit MAI 3 — Date of Service Edit: Clinical · Nature of Service/Procedure
- outpatient
- 1 unit MAI 3 — Date of Service Edit: Clinical · Nature of Service/Procedure
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for G9685
- Long descriptor
- Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project
- Short descriptor
- Acute nursing facility care
- Added
- October 1, 2016
- BETOS
- Z2
- 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 G9685
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9685 is not quite right, the correct code is very often within a few positions of it.
- G9677All quality actions for the applicable measures in the cardiovascular prevention measures group have been performed for this patientterminated
- G9678Oncology care model (ocm) monthly enhanced oncology services (meos) payment for ocm enhanced services. g9678 payments may only be made to ocm practitioners for ocm beneficiaries for the furnishment of enhanced services as defined in the ocm participation agreementterminated
- G9679This code is for onsite acute care treatment of a nursing facility resident with pneumonia; may only be billed once per day per beneficiary
- G9680This code is for onsite acute care treatment of a nursing facility resident with chf; may only be billed once per day per beneficiary
- G9681This code is for onsite acute care treatment of a resident with copd or asthma; may only be billed once per day per beneficiary
- G9682This code is for the onsite acute care treatment a nursing facility resident with a skin infection; may only be billed once per day per beneficiary
- G9683Facility service(s) for the onsite acute care treatment of a nursing facility resident with fluid or electrolyte disorder. (may only be billed once per day per beneficiary). this service is for a demonstration project
- G9684This code is for the onsite acute care treatment of a nursing facility resident for a uti; may only be billed once per day per beneficiary
- G9686Onsite nursing facility conference, that is separate and distinct from an evaluation and management visit, including qualified practitioner and at least one member of the nursing facility interdisciplinary care teamterminated
- G9687Hospice services provided to patient any time during the measurement period
- G9688Patients using hospice services any time during the measurement period
- G9689Patient admitted for performance of elective carotid intervention
- G9690Patient receiving hospice services any time during the measurement period
- G9691Patient had hospice services any time during the measurement period
- G9692Hospice services received by patient any time during the measurement period
- G9693Patient use of hospice services any time during the measurement period
Questions about G9685
What is HCPCS code G9685?
G9685 is a HCPCS Level II code for physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. this service is for a demonstration project. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9685?
The CMS HCPCS file marks G9685 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G9685 paid under the physician fee schedule?
G9685 carries PFS status code A. Active code. Paid separately under the physician fee schedule.