G9004 Mccd, risk adj lo, initial

Coordinated care fee, risk adjusted low, initial

Medicare pricing for G9004

Physician Fee Schedule (CY 2026, RVU26D)

Status X: statutory exclusion, not paid under the PFS.

Payer policies and prior authorization for G9004

Payer coverage policies that name G9004

G9004 appears in 1 coverage policy from Blue Shield of California.

PayerPolicyRole in policyReviewedDocument
Blue Shield of CaliforniaBSC2.11 | Diabetes Prevention Programlisted, no stancepayer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • ND: $0.00 (physician), effective Aug 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.