G9765 HCPCS code: Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi
G9765 is the HCPCS Level II code for documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi. 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 | 2017-01-01 |
| Last action effective | 2019-01-01 |
What changed for G9765
- 2017-01-01: G9765 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 G9765?
G9765 is the HCPCS Level II code for documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi. Short descriptor: "Doc pat declined therapy".
Does Medicare cover G9765?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G97 codes
- G9700 — Patients who use hospice services any time during the measurement period
- G9701 — Children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established
- G9702 — Patients who use hospice services any time during the measurement period
- G9703 — Episodes where the patient is taking antibiotics (table 1) in the 30 days prior to the episode date
- G9704 — Ajcc breast cancer stage i: t1 mic or t1a documented
- G9705 — Ajcc breast cancer stage i: t1b (tumor > 0.5 cm but <= 1 cm in greatest dimension) documented
- G9706 — Low (or very low) risk of recurrence, prostate cancer
- G9707 — Patient received hospice services any time during the measurement period
- G9708 — Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy
- G9709 — Hospice services used by patient any time during the measurement period
- G9710 — Patient was provided hospice services any time during the measurement period
- G9711 — Patients with a diagnosis or past history of total colectomy or colorectal cancer
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Next steps
- Run a reimbursement report for a device billed under G9765
- Watch G9765 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G9765
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.