G9862 HCPCS code: Documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons)
G9862 is the HCPCS Level II code for documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons). 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 | 2017-01-01 |
What changed for G9862
- 2017-01-01: G9862 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 G9862?
G9862 is the HCPCS Level II code for documentation of medical reason(s) for not recommending at least a 10 year follow-up interval (e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons). Short descriptor: "Doc rsn no 10 yr follow".
Does Medicare cover G9862?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G98 codes
- G9800 — Patients who are identified as having an intolerance or allergy to beta-blocker therapy
- G9801 — Hospitalizations in which the patient was transferred directly to a non-acute care facility for any diagnosis
- G9802 — Patients who use hospice services any time during the measurement period
- G9803 — Patient prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
- G9804 — Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami
- G9805 — Patients who use hospice services any time during the measurement period
- G9806 — Patients who received cervical cytology or an hpv test
- G9807 — Patients who did not receive cervical cytology or an hpv test
- G9808 — Any patients who had no asthma controller medications dispensed during the measurement year
- G9809 — Patients who use hospice services any time during the measurement period
- G9810 — Patient achieved a pdc of at least 75% for their asthma controller medication
- G9811 — Patient did not achieve a pdc of at least 75% for their asthma controller medication
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Next steps
- Run a reimbursement report for a device billed under G9862
- Watch G9862 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G9862
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.