Billing Code Overview

HCPCS Level II code G0175 describes a scheduled interdisciplinary team conference that requires a minimum of three team members (exclusive of patient care nursing staff) with the patient present. The service is categorized under Geriatrics and is typically provided in a Skilled Nursing Facility (POS 31).

Clinical Context

An 82-year-old resident of a skilled nursing facility (POS 31) with progressive cognitive decline and intermittent confusion is scheduled for a billed interdisciplinary team conference with the patient present. The patient’s primary care geriatrician, geriatric nurse practitioner, and a psychiatry consultant convene with the facility’s social worker and physical therapist (minimum three participants exclusive of patient-care nursing staff) to review the patient’s cognitive status, medication regimen, advance care planning, and goals of care. The team meets at the facility with the patient present, documents the discussion and care plan, and the physician bills HCPCS Level II code G0175 for the scheduled interdisciplinary team conference.

Coding Specifications

• Modifier 27: Multiple outpatient Evaluation and Management encounters on the same date. Use when the same provider reports more than one outpatient E/M service for the same patient on the same date and payer guidance allows reporting of multiple encounters.

• Associated provider taxonomies:

• Notes on specialties:

• Geriatric Medicine Physician (207QG0300X): specialist in comprehensive care of older adults.

• Geriatric Nurse Practitioner (163WG0000X): advanced practice nurse focusing on older adults’ primary and chronic care.

• Psychiatry & Neurology Physician (2084P0800X): physician focusing on psychiatric and neurologic conditions relevant to cognition and behavior.

Related Diagnoses

• Z00.00 — Encounter for general adult medical examination without abnormal findings

  Relevant because routine comprehensive examinations or screening visits may trigger interdisciplinary review and care planning during a team conference billed with G0175.

• Z00.01 — Encounter for general adult medical examination with abnormal findings

  Relevant when findings from an exam prompt interdisciplinary discussion of diagnostic results, treatment changes, or care coordination in a team conference.

• Z13.89 — Encounter for screening for other disorder

  Relevant when screening results or preventive care needs identified in the facility prompt an interdisciplinary meeting with the patient present.

• F03.90 — Unspecified dementia without behavioral disturbance

  Relevant because dementia care frequently requires interdisciplinary care planning, medication review, and goals-of-care discussion during a scheduled team conference.

• R41.82 — Altered mental status, unspecified

  Relevant when changes in cognition or mental status require interdisciplinary assessment, differential diagnosis, and coordinated care planning that are addressed in the conference billed with G0175.

Related Codes

• Relationship to G0175:

• 99304, 99305, 99306 are initial nursing facility evaluation and management codes used when a clinician performs a comprehensive initial assessment in the nursing facility setting; these may be billed instead of or in addition to G0175 depending on the service performed and payer rules.

• 99307, 99308 are subsequent nursing facility E/M codes for ongoing inpatient nursing facility care; they may be billed for face-to-face follow-up visits in the facility and can be billed on the same date as G0175 only if payer policies allow and appropriate modifiers or documentation support separate services.

• Common use patterns: G0175 is used specifically for scheduled interdisciplinary team conferences with the patient present; the 9930x series covers direct physician or advanced practitioner E/M encounters in the nursing facility and are alternatives when the encounter is an individual evaluation rather than a multidisciplinary conference.

National commercial averages are generally above Medicare for this HCPCS Level II code G0175 when comparing BUCA (average commercial) mean rate of $106.39 to Medicare (reported as $0.00 in the input). Blue Cross Blue Shield and UnitedHealthcare show substantially higher mean rates relative to other commercial payers, with UnitedHealthcare at $948.04 driving the upper bound of the national mean distribution.

Rate dispersion varies widely across payers. UnitedHealthcare has the widest spread (P75 − P25 = $869.00), followed by Blue Cross Blue Shield (P75 − P25 = $398.00). Aetna and Cigna Health display the tightest distributions (Aetna P75 − P25 = $0.00; Cigna Health P75 − P25 = $10.00). The table and chart below present the full breakdown of mean rates and percentiles for each payer.