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Nursing Facility Evaluation for Acute Change in Condition

New Jersey rates for HCPCS G9685

Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. This service is for a demonstration project

Rates data updated July 2026.

Facilitymedian $178 · 10th–90th $178$1780%50%100%$178Professionalmedian $178 · 10th–90th $145$2240%20%10th90th$178$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$154.88
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$218.78
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$177.83
Typical High
$346.74