HCPCS G9490: Model home visitMedicare rate & RVUs in Guam
A CMMI model-specific service for a clinician's home visit, reported when the encounter meets the participating model's documentation and billing requirements.
Medicare pays $56.72 for G9490 in the office in Guam (Hawaii, Guam). 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 G9490 covers
G9490 identifies a home visit furnished under a Center for Medicare & Medicaid Innovation (CMMI) model. The CMS short descriptor does not identify a diagnosis, specialty, or visit complexity. The code is tied to the model-designated encounter at the patient's home, rather than serving as a general label for every clinician visit performed there.
Support the claim with the visit note and records identifying the home setting, rendering professional, and model pathway. The CMS PFS file assigns 0.18 work RVUs, 1.32 practice-expense RVUs in both office and facility settings, and 0.03 malpractice RVUs. Do not infer an E/M level or time threshold from this short descriptor; document the service as required by the participating model. The code's 2024 Medicare volume was zero in both office and facility settings.
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.
G9490 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | $56.72 | Unavailable |
How the G9490 rate is calculated
Each of G9490’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 · G9490
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.18Practice expense 1.32Malpractice 0.03
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for G9490
G9490 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 · G9490
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$51.10
Only one setting is priced for this code.
G9490 compared with similar codes
Compare codes
G9490 vs G9481 vs G9486 vs 99349: national Medicare rates
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How to choose
- G9481Remote E/M
- G9481 is labeled for remote E/M for a new patient with a stated time label. G9490 identifies a CMMI model home visit.
- G9486Remote E/M
- G9486 is labeled for remote E/M for an established patient. G9490 is tied to a home visit under a CMMI model.
- 99349Home visit
- 99349 describes established-patient home or residence E/M. G9490 identifies a model-designated home visit, not an ordinary E/M level.
G9490 billing questions
How is G9490 different from the remote E/M codes G9481 and G9486?
G9490 identifies a CMMI model home visit. G9481 and G9486 identify remote E/M services, with different patient-status and time labels.
Can G9490 replace a regular home or residence E/M code?
Use G9490 for the model-designated home visit. A standard home or residence E/M code describes a different service context and should not be substituted solely because the encounter occurred at home.
What documentation should support G9490?
The record should identify the home setting, date, rendering professional, work performed, and the CMMI model pathway associated with the visit.
Does the descriptor establish a time threshold or E/M level?
No time threshold or E/M level is stated in the short descriptor. Document the model-defined encounter rather than deriving a level from the label.
Can G9490 be reported with another E/M service on the same date?
The descriptor does not establish that a separate E/M service is supported. The documentation should distinguish any separately reported work from the model home visit.
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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