G8946 HCPCS code: Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells)
G8946 is the HCPCS Level II code for minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells). 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 | 2013-01-01 |
| Last action effective | 2014-01-01 |
What changed for G8946
- 2013-01-01: G8946 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 G8946?
G8946 is the HCPCS Level II code for minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells). Short descriptor: "Mibm but no dx of breast ca".
Does Medicare cover G8946?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G89 codes
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- G8903 — I intend to report the parkinson's disease measures group
- G8904 — I intend to report the hypertension (htn) measures group
- G8905 — I intend to report the cardiovascular prevention measures group
- G8906 — I intend to report the cataract measures group
- G8907 — Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility
- G8908 — Patient documented to have received a burn prior to discharge
- G8909 — Patient documented not to have received a burn prior to discharge
- G8910 — Patient documented to have experienced a fall within asc
- G8911 — Patient documented not to have experienced a fall within ambulatory surgical center
- G8912 — Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event
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Next steps
- Run a reimbursement report for a device billed under G8946
- Watch G8946 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G8946
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.