Question 1

What is HCPCS code G2065?

Accepted Answer

HCPCS code G2065 is "Clin mang h risk dx 30". Comprehensive care management for a single high-risk disease services, e.g. principal care management, at least 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities

Question 2

What category is G2065 in?

Accepted Answer

G2065 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G2065?

Accepted Answer

Use G2065 when billing for clin mang h risk dx 30. 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 G2065 covered by Medicare?

Accepted Answer

Coverage for G2065 (Clin mang h risk dx 30) 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 G2065?

Accepted Answer

Documentation for G2065 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).