G9487

Remote evaluation and management visit for an established patient, lasting approximately 15 minutes, conducted in real time via interactive audio and video technology — restricted to use within a CMS Innovation Center demonstration project.

Verified May 8, 2026 · 5 sources ↓

Medicare: $35.40
Total RVUs: 1.06
Global, days
Region: General

Drawn from CMSPayerpriceAAOS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Confirm and document patient's established status prior to the visit
Identify the specific CMS Innovation Center demonstration project under which the visit is furnished
Record that the visit was conducted in real time using interactive audio and video technology — audio-only does not qualify
Document at least two of three key components: expanded problem-focused history, expanded problem-focused examination, or low-complexity medical decision-making
Note the time spent with the patient or family via the audio-video platform (approximately 15 minutes)
Document the presenting problem(s) and their severity to support low-to-moderate complexity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

25 Significant separate E/M 52 Reduced services 76 Repeat, same physician 77 Repeat, another physician 79 Unrelated during global 95 Modifier

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

G9487 is a HCPCS Level II code covering a low-complexity, real-time telehealth E/M visit for an established patient, approximately 15 minutes in duration. Use is strictly limited to Medicare-approved CMS Innovation Center demonstration projects — it is not a general-purpose telehealth E/M code and cannot be billed outside that program context. The visit requires at least two of three key components: expanded problem-focused history, expanded problem-focused examination, or low-complexity medical decision-making. Problems addressed are typically of low to moderate severity.

The global period designation is XXX, meaning no global period applies — post-visit services are not bundled, and there is no pre- or post-operative period to manage. Orthopedic surgery appears among the top billing specialties in CMS Part B data, reflecting use in musculoskeletal telehealth programs operating under demonstration authority.

Because this code is tied to demonstration project eligibility, documentation must explicitly support that the visit occurred under an approved CMS Innovation Center program. Payers outside Medicare — and even some Medicare Administrative Contractors — may not recognize or reimburse this code; verify coverage before billing commercial or Medicaid plans.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	0.97
Practice expense RVU	0
Malpractice RVU	0.09
Total RVU	1.06
Medicare national rate	$35.40
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$35.40

Common denial reasons

The recurring reasons claims for CPT G9487 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Service billed outside an approved CMS Innovation Center demonstration project — the eligibility prerequisite is not met
Visit conducted via audio-only technology rather than real-time interactive audio and video
Patient billed as new rather than established — G9487 is restricted to established patients
Commercial or non-Medicare payer does not recognize HCPCS G9487 as a covered service
Insufficient documentation of the two required key components from the three-component set

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can G9487 be billed for any telehealth visit with an established patient?

No. G9487 is restricted to visits furnished within a Medicare-approved CMS Innovation Center demonstration project. It is not interchangeable with standard telehealth E/M codes like 99213 or 99214.

02Does G9487 have a global period?

The global period is XXX — no global period applies. There are no bundled pre- or post-visit services, so each encounter is billed independently.

03What if only audio (phone) is available — can G9487 still be used?

No. The code requires real-time interactive audio and video technology. Audio-only encounters do not satisfy the requirement and should be coded with the appropriate telephone or audio-only E/M code if covered.

04Can orthopedic surgeons bill G9487 outside of a demonstration project?

No. Even though orthopedic surgery is among the top billing specialties in CMS Part B data, the demonstration project requirement applies to all specialties. Verify your practice's participation in an approved CMS Innovation Center program before submitting.

05How does G9487 differ from standard telehealth E/M codes?

Standard telehealth E/M codes (99202–99215 with modifier 95) are broadly available for Medicare telehealth. G9487 is a HCPCS G-code available only within specific CMS Innovation Center programs, with its own documentation and eligibility requirements distinct from the CPT E/M framework.

06Is G9487 payable in a hospital outpatient or ASC setting?

No HOPD or ASC payment rates are established for G9487. This is a professional service code tied to demonstration project participation and is not applicable to facility billing.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the real-time audio-video platform used, confirms established patient status, and documents at least two of the three required key components — history, exam, and MDM — along with the time spent and the CMS Innovation Center program under which the visit was furnished. That prevents the most common denial: a missing or vague demonstration project reference that flags the claim as ineligible for G9487 reimbursement.

See how Mira captures CPT G9487 documentation