G8540 HCPCS code: Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter
G8540 is the HCPCS Level II code for functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | M5D |
| Added | 2009-01-01 |
| Last action effective | 2018-01-01 |
What changed for G8540
- 2009-01-01: G8540 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G8540?
G8540 is the HCPCS Level II code for functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter. Short descriptor: "Foa not doc as being perf".
Does Medicare cover G8540?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G85 codes
- G8500 — All quality actions for the applicable measures in the hiv/aids measures group have been performed for this patient
- G8501 — All quality actions for the applicable measures in the perioperative care measures group have been performed for this patient
- G8502 — All quality actions for the applicable measures in the back pain measures group have been performed for this patient
- G8506 — Patient receiving angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
- G8509 — Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given
- G8510 — Screening for depression is documented as negative, a follow-up plan is not required
- G8511 — Screening for depression documented as positive, follow-up plan not documented, reason not given
- G8530 — Autogenous av fistula received
- G8531 — Clinician documented that patient was not an eligible candidate for autogenous av fistula
- G8532 — Clinician documented that patient received vascular access other than autogenous av fistula, reason not given
- G8535 — Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter related to one of the following reasons: (1) patient refuses to participate in the screening and has reasonable decisional capacity for self-protection, or (2) patient is in an urgent or emergent situation where time is of the essence and to delay treatment to perform the screening would jeopardize the patient's health status
- G8536 — No documentation of an elder maltreatment screen, reason not given
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Next steps
- Run a reimbursement report for a device billed under G8540
- Watch G8540 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G8540
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.