G9004 — Coordinated care fee, risk adjusted low, initial
G9004 is a HCPCS Level II code for coordinated care fee, risk adjusted low, initial. 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 G9004
- Long descriptor
- Coordinated care fee, risk adjusted low, initial
- Short descriptor
- Mccd, risk adj lo, initial
- Added
- October 1, 2000
- 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 G9004
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9004 is not quite right, the correct code is very often within a few positions of it.
- G8995Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reportingterminated
- G8996Swallowing functional limitation, current status at therapy episode outset and at reporting intervalsterminated
- G8997Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reportingterminated
- G8998Swallowing functional limitation, discharge status, at discharge from therapy or to end reportingterminated
- G8999Motor speech functional limitation, current status at therapy episode outset and at reporting intervalsterminated
- G9001Coordinated care fee, initial rate
- G9002Coordinated care fee, maintenance rate
- G9003Coordinated care fee, risk adjusted high, 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
- G9011Coordinated care fee, risk adjusted maintenance, level 5
- G9012Other specified case management service not elsewhere classified
Questions about G9004
What is HCPCS code G9004?
G9004 is a HCPCS Level II code for coordinated care fee, risk adjusted low, initial. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9004?
The CMS HCPCS file marks G9004 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 G9004 paid under the physician fee schedule?
G9004 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.