HCPCS G9685: Nursing facility careMedicare rate & RVUs in Delaware
Identifies acute nursing facility care in CMS coding; the descriptor distinguishes this setting from acute care reported by diagnosis.
Medicare pays $155.90 for G9685 in the office in Delaware (Delaware). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What G9685 covers
G9685 is labeled for acute nursing facility care. The CMS descriptor identifies the care setting and acute-care context, but does not specify a particular diagnosis, visit level, procedure, or clinical threshold. The code is relevant to care furnished in a nursing facility rather than an acute-care hospital. The supplied CMS facts do not identify a particular provider type or give clinical criteria that would further define the service.
For code selection, documentation should support that the care was acute and furnished in a nursing facility, including the encounter date and the clinical work performed. The CMS fee schedule file assigns work, practice expense, and malpractice relative value units to G9685; the file does not provide a separate add-on, global-period, component, or multiple-procedure instruction for this code. CMS reported no office or facility services for G9685 in 2024. That utilization figure describes the reported data, not a clinical selection criterion.
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.
G9685 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | $155.90 | $155.90 |
How the G9685 rate is calculated
Each of G9685’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.
How the rate is built · G9685
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.50Practice expense 0.90Malpractice 0.29
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G9685
G9685 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.
Place of service · G9685
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$156.65
The facility rate would be $156.65 (−$0.00). In a facility, the facility bills its own costs separately.
G9685 compared with similar codes
Compare codes
G9685 vs G9679 vs G9680 vs G9684: national Medicare rates
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How to choose
- G9679Acute care pneumonia
- G9679 is identified for acute care involving pneumonia. G9685 is labeled for acute nursing facility care and does not name a diagnosis.
- G9680Acute care congestive heart
- G9680 is identified for acute care involving congestive heart failure. G9685 distinguishes acute nursing facility care without specifying a condition.
- G9684Acute care urinary tract inf
- G9684 is identified for acute care involving urinary tract infection. G9685 identifies the nursing facility care context rather than that diagnosis.
G9685 billing questions
How does G9685 differ from an acute-care hospital code?
G9685 is labeled for acute nursing facility care. The nearby G9679–G9684 codes identify acute care by condition, such as pneumonia or urinary tract infection.
Does the descriptor identify a specific diagnosis or visit level?
No. The CMS descriptor identifies acute nursing facility care but does not state a diagnosis, visit level, or clinical threshold.
What documentation supports reporting G9685?
The record should establish that the care was acute and occurred in a nursing facility, and describe the date and clinical work performed.
Does G9685 have a professional or technical component?
The supplied CMS facts assign work, practice expense, and malpractice relative value units, but do not identify separate professional and technical components.
Does the CMS file show services reported for G9685 in 2024?
The supplied data show zero office services and zero facility services for 2024.
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
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