HCPCS code G0085: Care management visit, established patient, 75 minutes2026 Medicare rate & RVUs

Medicare pays $217.11 for G0085 nationally in the office. Local office rates run $202.88–$286.35.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What G0085 covers

G0085 represents an extended care-management visit in an established patient’s home. The clinician addresses the patient’s ongoing care needs during the home encounter. The code identifies both the established-patient status and the 75-minute service level; it differs from the new-patient home-visit level and from a home-care-plan service. The related established-patient visit codes describe shorter time levels.

Report G0085 when the patient is established, the service is a home visit for care management, and the documented time supports this level. Documentation should identify the patient’s status, the home setting, the care-management work performed, and the time associated with the visit. CMS values the service in the Physician Fee Schedule using physician-work, practice-expense, and malpractice RVUs.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where G0085 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

G0085 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the G0085 rate is calculated

Each of G0085’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for G0085

G0085 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

G0085 compared with similar codes

How to choose

G0084Home care managementEstablished patient, 60 minutes

Use G0084 for the 60-minute established-patient home-visit level; G0085 is the 75-minute level.

G0080Home care managementNew patient, 75 minutes

Both represent a 75-minute care-management home visit, but G0080 is for a new patient and G0085 is for an established patient.

G0086Care managementHome care plan, 30 minutes

G0086 identifies a home care plan service at 30 minutes; G0085 identifies a 75-minute established-patient care-management home visit.

Codes related to G0085

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates