$99.80–$106.77
Both address management of a home care plan. G0086 is the 30-minute code; G0087 is the 60-minute code.
On this page
CMS RVU26D · Effective 2026-10-01
G0086 Care management Medicare reimbursement rates in Pennsylvania
Reports 30 minutes of care-management work focused on a patient's home care plan, rather than a timed care-management visit in the home. Compare G0086 office and facility rates across CMS payment localities in Pennsylvania.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for G0086 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$71.28–$76.39
2 of 2 localities have a supported rate.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Care management
About G0086: Home care plan management, 30 minutes
Reports 30 minutes of care-management work focused on a patient's home care plan, rather than a timed care-management visit in the home.
G0086 represents care-management work directed at a patient's home care plan for a 30-minute service interval. The work may include reviewing the patient's status, coordinating information about care, and managing the plan as needs change. A physician or other qualified health care professional overseeing the patient's care may perform this work in a practice or other setting; the code describes plan-focused management, not a home visit.
Choose G0086 when the documented service is management of the home care plan and supports the 30-minute code, rather than a timed new- or established-patient home visit. Record the time and the plan-related work performed, such as review, coordination, and resulting care-plan actions. The record should make clear how the work relates to the patient's home care plan. CMS lists no additional payment rules for this code in the supplied facts.
Where the value comes from
- Work RVU1.25 · 57%
- Practice expense (office) RVU0.86 · 39%
- Malpractice RVU0.10 · 5%
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.
G0086 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$72.60–$76.73
G0077 describes a 30-minute care-management home visit for a new patient. G0086 describes plan-management work rather than the home visit.
$78.54–$83.30
G0082 describes a 30-minute care-management home visit for an established patient. G0086 is for management of the home care plan, not the visit.
Compare G0086 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$76.39
Facility
Unavailable
Rest Of Pennsylvania →
Office / nonfacility
$71.28
Facility
Unavailable
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G0086 billing questions
How does G0086 differ from a home-visit care-management code?
G0086 is for time spent managing a home care plan. G0077 and G0082 describe timed home visits for new and established patients, respectively.
When should the 30-minute code be selected?
Select G0086 when the documented service is plan-focused care management and supports its 30-minute interval. Do not select it just because care relates to a patient who receives services at home.
What documentation supports G0086?
Document the time spent, the patient's home care plan, and the specific review, coordination, or plan-management work performed.
How does G0086 differ from G0087?
Both describe management of a home care plan; G0086 is the 30-minute code, while G0087 is the 60-minute code.
Is G0086 reported for an in-home patient encounter?
The code represents plan-management work, not a timed home visit. Use the home-visit code family when the service is a qualifying care-management 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
15,075G0083,,Care man h v ext pt 45 m,A,,2.33,1.36,,1.36,NA,0.16,3.85,3.85,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,076G0084,,Care man h v ext pt 60 m,A,,3.28,1.94,,1.94,NA,0.24,5.46,5.46,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,077G0085,,Care man h v ext pt 75 m,A,,4.09,2.16,,2.16,NA,0.25,6.50,6.50,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,078G0086,,Care man home care plan 30 m,A,,1.25,0.86,,0.86,NA,0.10,2.21,2.21,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,079G0087,,Care man home care plan 60 m,A,,1.80,1.15,,1.15,NA,0.14,3.09,3.09,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,080G0088,,Adm iv drug 1st home visit,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
15,081G0089,,Adm subq drug 1st home visit,X,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00