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HCPCS G9685

G9685 EVALUATION AND MANAGEMENT OF A BENEFICIARY?S

Reported by 11 hospitals in the network under the case rate methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

National pricing summary

Low

$149

Average

$168

Median

$177

High

$187

Hospitals reporting this code

#HospitalLocation
1IOM Health System LPFort Wayne, IN$128$149$149$519—
2Dukes Health System LLCPeru, IN$102$149$149$830—
3Warsaw Health System LLCWarsaw, IN$109$149$149$519—
4Lutheran Musculoskeletal Center LLCFort Wayne, IN$124$187$187$519—
5La Porte Hospital Company LLCLa Porte, IN$140$149$149$485—
6Sanford Fargo Medical CenterFargo, ND$165$179$177$322$5
7Sanford Medical Center BismarckBismarck, ND$166$180$178$184$5
8Sanford Bemidji Medical CenterBemidji, MN$165$179$177$327$5
9Sanford USD Medical CenterSioux Falls, SD$165$179$177$322$5
10Sanford Aberdeen Medical CenterAberdeen, SD$165$179$177$182$5
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