HCPCS code G9012: Other specified case management service not elsewhere classified

Learn more about how to use HCPCS code G9012 in our short guide that comes with a list of documentation and billing services.

Use Code

## **What is HCPCS code G9012?** HCPCS code G9012, under the code range MCCD (Medicare Coordinated Care Demonstration, is used to denote Enhanced Care Management (ECM) services delivered by non-clinical staff. It's description code is as follows: HCPCS code for Other specified case management service not elsewhere classified as maintained by CMS falls under MCCD (Medicare Coordinated Care Demonstration). Under this classification, non‐licensed personnel provide case management or care coordination services that are not otherwise categorized. These services may be provided in-person, by phone (telehealth), or as specific outreach efforts, such as initial contact attempts to engage a member in ECM.

## **HCPCS code G9012 documentation requirements** Documentation must clearly indicate: - The service was provided by non-clinical staff, such as care coordinators or community health workers. - The mode of service delivery, whether in-person, telephonic, or electronic. - Whether it was a standard case management encounter or a designated outreach attempt. - Contextual information for care coordination, such as the participant’s status (e.g., new or transitioning member), and any follow-up action. Additionally, the use of modifiers (e.g., U2 for non-clinical delivery; U8 for outreach; GQ for telehealth) must be documented accurately to support billing.

## **G9012 billing requirements** To prevent the denial of claims, the following requirements must be kept in mind: - Billing requires pairing G9012 with the appropriate modifier(s): U2 for non-clinical staff services (in-person), U2 + GQ for telehealth, U8 for outreach (single attempt, in-person), or U8 + GQ for outreach via telehealth. - Frequency and payment details vary by program. For example: $400 per member per month (PEPM) may apply to standard in-person or telehealth services, requiring a Treatment Authorization Request (TAR). $150 one-time payment may be authorized for successful enrollment into ECM. Outreach attempts generally carry no PEPM payment and require proper documentation, but no TAR.

## **Other relevant codes** - **G9008**: ECM services provided by clinical staff (including in-person and telehealth variants, with modifiers U1, GQ, U8) - **H0006**: Alcohol and/or drug services; case management.

Frequently asked questions

G9012 is specifically for case management delivered by non-clinical staff. In contrast, G9008 applies when clinical staff (e.g., MDs, NPs, RNs, LCSWs) deliver ECM services. Proper differentiation ensures correct billing and reimbursement.

No, documentation of outreach using G9012 + U8 (or with GQ for telehealth) typically does not require a TAR, though the activity must be documented. However, routine ECM services (U2 or U2, GQ) generally do require a TAR.

Yes, G9012 with the appropriate modifier (such as U8) can be used to bill for outreach attempts, regardless of whether the outreach attempt was successful in engaging the member. A separate billing may be allowed for a successful engagement.