Summary & Overview
HCPCS G0036: Patient or Care Partner Decline Assessment
HCPCS Level II code G0036 denotes a documented assessment when a patient or their care partner declines a recommended evaluation or service. This code captures the clinical and administrative action of assessing capacity, reasons for refusal, and any counseling or education provided at the time of decline. Nationally, accurate use of this code matters for care continuity, quality reporting, and clear clinical documentation when services are refused.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical purpose and appropriate settings, a summary of payer coverage patterns where available, and context on how the code fits into assessment and care-planning workflows. The publication also outlines common modifiers and typical service lines associated with documentation of declines, and highlights policy or billing considerations relevant to providers and billing professionals.
This summary is intended to give clinicians, coders, and administrators a national-level reference for the clinical meaning and administrative role of HCPCS Level II code G0036, where it is used, and what to expect when this code appears in the medical record or claims.
Billing Code Overview
HCPCS Level II code G0036 represents patient or care partner decline assessment. The service type is an assessment of a patient or their care partner when they decline recommended evaluation or services. The typical site of service for this code is outpatient or ambulatory settings where assessments and care planning occur, including clinics, physician offices, and home health or community-based encounters where a decline is documented.
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Clinical & Coding Specifications
Clinical Context
A patient scheduled for a comprehensive home health assessment declines the visit-based assessment offered by a visiting nurse or care coordinator. Typical scenario: an elderly patient with multiple chronic conditions (e.g., heart failure, diabetes, COPD) who was contacted for a Medicare-covered home health assessment refuses to participate. The clinician documents the refusal after attempting to explain the purpose, risks, benefits, and alternatives, and records that the patient or designated care partner declined the assessment. The workflow includes outreach (phone or in-person), documentation of informed refusal, attempts to reschedule when appropriate, and billing the encounter using G0036 to reflect the declined assessment. The typical site of service is the patientâs residence or home health agency-originated visit. Common care team members include a home health nurse, social worker, or care coordinator who attempt the assessment and complete the refusal documentation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the professional component applies for a related service provided by a physician. |
52 |