G8865 HCPCS code: Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)
G8865 is the HCPCS Level II code for documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction). 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 | M5B |
| Added | 2012-01-01 |
| Last action effective | 2012-01-01 |
What changed for G8865
- 2012-01-01: G8865 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 G8865?
G8865 is the HCPCS Level II code for documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction). Short descriptor: "Doc med reas no pneumococcal".
Does Medicare cover G8865?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G88 codes
- G8806 — Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented
- G8807 — Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup])
- G8808 — Trans-abdominal or trans-vaginal ultrasound not performed, reason not given
- G8809 — Rh-immunoglobulin (rhogam) ordered
- G8810 — Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal)
- G8811 — Documentation rh-immunoglobulin (rhogam) was not ordered, reason not given
- G8815 — Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease)
- G8816 — Statin medication prescribed at discharge
- G8817 — Statin therapy not prescribed at discharge, reason not given
- G8818 — Patient discharge to home no later than post-operative day #7
- G8825 — Patient not discharged to home by post-operative day #7
- G8826 — Patient discharged to home no later than post-operative day #2 following evar
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Next steps
- Run a reimbursement report for a device billed under G8865
- Watch G8865 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G8865
Sources: CMS HCPCS Level II release October 2026; 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.