$185.72
Use G0084 for the 60-minute established-patient home-visit level; G0085 is the 75-minute level.
On this page
CMS RVU26D · Effective 2026-10-01
G0085 Care management visit Medicare reimbursement rates in Rhode Island
Reports a 75-minute care-management home visit for an established patient, distinguished from shorter visit levels and the corresponding new-patient service. Compare G0085 office and facility rates across CMS payment localities in Rhode Island.
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 G0085 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$221.18
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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 G0085: Established-patient care management home visit
Reports a 75-minute care-management home visit for an established patient, distinguished from shorter visit levels and the corresponding new-patient service.
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.
Where the value comes from
- Work RVU4.09 · 63%
- Practice expense (office) RVU2.16 · 33%
- Malpractice RVU0.25 · 4%
240
Medicare services in 2024 · #4167 by national volume
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.
G0085 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$221.18
Both represent a 75-minute care-management home visit, but G0080 is for a new patient and G0085 is for an established patient.
$75.20
G0086 identifies a home care plan service at 30 minutes; G0085 identifies a 75-minute established-patient care-management home visit.
Compare G0085 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
$221.18
Facility
Unavailable
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for G0085 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
15,077
- Code
- G0085
- Physician work
- 4.09
- Practice expense
- 2.16
- Malpractice
- 0.25
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.09 | × 1.019 | 4.1677 |
| Practice expense | 2.16 | × 1.033 | 2.2313 |
| Malpractice | 0.25 | × 0.892 | 0.2230 |
| Total RVUs | 6.6220 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$221.18
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.09 | 1.019 |
| Practice expense | 2.16 | 1.033 |
| Malpractice | 0.25 | 0.892 |
(4.09 × 1.019 + 2.16 × 1.033 + 0.25 × 0.892) × $33.4009 = $221.18
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
G0085 billing questions
How does G0085 differ from G0084?
Both describe care-management home visits for established patients. G0085 is the 75-minute level; G0084 is the 60-minute level.
Can G0085 be used for a new patient?
No. G0085 is the established-patient level. G0080 is the corresponding 75-minute home-visit level for a new patient.
What time should the documentation support?
The record should support the 75-minute service level and describe the care-management work performed during the home visit.
How is G0085 different from G0086?
G0085 describes an established-patient care-management home visit. G0086 describes a home care plan service at the 30-minute level.
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.
15,074G0082,,Care man h v ext pt 30 m,A,,1.56,0.79,,0.79,NA,0.07,2.42,2.42,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
15,075G0083,,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
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537