G9400 HCPCS code: Documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons
G9400 is the HCPCS Level II code for documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons. CMS terminated G9400 on 2021-12-31; do not bill it for later dates of service. 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 | Z2 |
| Added | 2015-01-01 |
| Last action effective | 2022-01-01 |
| Terminated | 2021-12-31 |
What changed for G9400
- 2015-01-01: G9400 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 G9400?
G9400 is the HCPCS Level II code for documentation of medical or patient reason(s) for not discussing treatment options; medical reasons: patient is not a candidate for treatment due to advanced physical or mental health comorbidity (including active substance use); currently receiving antiviral treatment; successful antiviral treatment (with sustained virologic response) prior to reporting period; other documented medical reasons; patient reasons: patient unable or unwilling to participate in the discussion or other patient reasons. Short descriptor: "Doc reas no disc tx opt".
Does Medicare cover G9400?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G94 codes
- G9401 — No documentation in the patient record of a discussion between the physician or other qualified healthcare professional and the patient that includes all of the following: treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward treatment
- G9402 — Patient received follow-up within 30 days after discharge
- G9403 — Clinician documented reason patient was not able to complete 30 day follow-up from acute inpatient setting discharge (e.g., patient death prior to follow-up visit, patient non-compliant for visit follow-up)
- G9404 — Patient did not receive follow-up within 30 days after discharge
- G9405 — Patient received follow-up within 7 days after discharge
- G9406 — Clinician documented reason patient was not able to complete 7 day follow-up from acute inpatient setting discharge (i.e patient death prior to follow-up visit, patient non-compliance for visit follow-up)
- G9407 — Patient did not receive follow-up within 7 days after discharge
- G9408 — Patients with cardiac tamponade and/or pericardiocentesis occurring within 30 days
- G9409 — Patients without cardiac tamponade and/or pericardiocentesis occurring within 30 days
- G9410 — Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
- G9411 — Patient not admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
- G9412 — Patient admitted within 180 days, status post cied implantation, replacement, or revision with an infection requiring device removal or surgical revision
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Next steps
- Run a reimbursement report for a device billed under G9400
- Watch G9400 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G9400
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.