G8969 HCPCS code: Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation)
G8969 is the HCPCS Level II code for documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation). 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 | 2022-01-01 |
What changed for G8969
- 2013-01-01: G8969 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 G8969?
G8969 is the HCPCS Level II code for documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation). Short descriptor: "Doc pt rsn no presc warf/fda".
Does Medicare cover G8969?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G89 codes
- G8900 — I intend to report the sleep apnea measures group
- G8902 — I intend to report the dementia measures group
- 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 G8969
- Watch G8969 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G8969
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.