HCPCS G0085: Care management visitMedicare rate & RVUs in Texas
Reports a 75-minute care-management home visit for an established patient, distinguished from shorter visit levels and the corresponding new-patient service.
Medicare pays $210.02–$220.83 for G0085 in the office in Texas, from Beaumont to Houston. 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 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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$210.02 to $220.83
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $220.61 | Unavailable |
| Beaumont | $210.02 | Unavailable |
| Brazoria | $215.71 | Unavailable |
| Dallas | $216.86 | Unavailable |
| Fort Worth | $216.25 | Unavailable |
| Galveston | $216.26 | Unavailable |
| Houston | $220.83 | Unavailable |
| Rest Of Texas | $212.62 | Unavailable |
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.
How the rate is built · G0085
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.09Practice expense 2.16Malpractice 0.25
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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.
Place of service · G0085
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$217.11
Only one setting is priced for this code.
G0085 compared with similar codes
Compare codes
G0085 vs G0084 vs G0080 vs G0086: national Medicare rates
Swap in your local Medicare rate.
How to choose
- G0084Home care management
- Use G0084 for the 60-minute established-patient home-visit level; G0085 is the 75-minute level.
- G0080Home care management
- Both represent a 75-minute care-management home visit, but G0080 is for a new patient and G0085 is for an established patient.
- G0086Care management
- G0086 identifies a home care plan service at 30 minutes; G0085 identifies a 75-minute established-patient care-management home visit.
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 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
Show the CMS file lines behind this rate
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