G0039 HCPCS Reimbursement & Policy | OpenPayer

Summary & Overview

HCPCS G0039: Patient Not Referred, Reason NOS

HCPCS Level II code G0039 denotes a record that a patient was not referred, with the reason not otherwise specified. As an administrative coding element, it captures referral or authorization status information that can affect care coordination, access to specialty services, and billing workflows. Nationally, consistent use of this code supports accurate claims processing and communication between primary care, specialty providers, and payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's purpose, common contexts where it is used, and what to consider when encountering it on a claim. The publication highlights benchmarks and common usage patterns where available, summarizes relevant policy considerations for major payers, and provides clinical context about how referral status codes interact with care coordination processes.

This summary is intended for billing managers, clinicians involved in referrals, and policy analysts seeking a national perspective on administrative coding for referral status. Data not available in the input will be indicated where applicable in the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG0039HCPCS Level IIreferral statusadministrative codeclaims processingcare coordinationoutpatient administration

Billing Code Overview

HCPCS Level II code G0039 is reported for a patient not referred, reason not otherwise specified. The service type indicated by this description is administrative documentation related to eligibility or referral status confirmation rather than a direct clinical procedure. The typical site of service for this code is administrative or outpatient settings where referral or authorization status is recorded, such as physician offices, clinic registration areas, or administrative offices.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult patient who is eligible for Medicare-covered preventive services but was not referred for an Advance Care Planning (ACP) or for a particular preventive counseling visit; the billing code G0039 is used to document that the patient was not referred and the reason is not otherwise specified. The clinical workflow begins when the patient presents for a primary care or preventive visit. The clinician assesses eligibility for covered services and documents that a referral for the specific service was not made. Documentation includes the clinical rationale, informed patient discussion when appropriate, and a note that no referral occurred. This code is typically reported by primary care physicians, nurse practitioners, or physician assistants during outpatient office-based preventive care or care-management encounters in a clinic or ambulatory setting where referral would otherwise be expected but is not completed for unspecified reasons.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when services require substantially greater effort or time than usual and documentation supports intensity beyond the standard service.

HCPCS G8797: Specimen From Non-Esophageal Site

HCPCS-G9007-COORDINATED-CARE-TEAM-CONFERENCE

HCPCS G9007: Coordinated Care Fee for Scheduled Team Conference

HCPCS-G8531-AV-FISTULA-INELIGIBILITY-DOCUMENTATION

HCPCS G8531: Clinician Documentation of AV Fistula Ineligibility

HCPCS-G9483-REMOTE-IN-HOME-NEW-PATIENT-EVALUATION-TELEHEALTH

HCPCS G9483: Remote In-Home New Patient Evaluation via Telehealth

HCPCS-G9898-INSTITUTIONAL-SNP-LONG-TERM-CARE-RESIDENCY-90-DAYS

HCPCS G9898: Institutional SNP or Long-Term Care Residency, Age 66+

HCPCS-G0019-COMMUNITY-HEALTH-INTEGRATION-SDOH-CARE-COORDINATION

HCPCS G0019: Community Health Integration for Social Determinants of Health

HCPCS-G9126-CML-REMISSION-STATUS-PHILADELPHIA-BCR-ABL-POSITIVE

HCPCS G9126: CML Remission Status, Philadelphia/BCR-ABL Positive

HCPCS-G9884-MDPP-TWO-ONGOING-MAINTENANCE-SESSIONS-MONTHS-19-21

HCPCS G9884: MDPP Two Ongoing Maintenance Sessions, Months 19–21

HCPCS-G9870-REMOTE-DERMATOLOGIC-OPHTHALMOLOGIC-IMAGE-ANALYSIS-20MIN-PLUS

HCPCS G9870: Remote Dermatologic and Ophthalmologic Image Analysis (>20 min)

HCPCS-G9778-PREGNANCY-DIAGNOSIS-MEASUREMENT-PERIOD

HCPCS G9778: Pregnancy Diagnosis During Measurement Period

Showing 1–10 of 1996

23

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary clinicians performing preventive visits and documenting absence of referral.
`208D00000X`	Internal Medicine	Clinic-based internists who manage preventive care and referrals.
`363L00000X`	Nurse Practitioner	Advanced practice clinicians who provide ambulatory preventive services and documentation.
`208000000X`	General Practice	General practitioners in outpatient or community clinic settings.
`2285S0113X`	Hospice and Palliative Medicine	Clinicians documenting advance care planning contexts where referrals may be considered.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z71.89`	Other specified counseling	Relevant for counseling or preventive discussions during which a referral was not made.
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Common preventive visit setting where a referral might be expected but not made.
`Z13.9`	Encounter for screening, unspecified	Screening encounters where further referral is sometimes indicated but not completed.
`Z02.89`	Encounter for administrative examinations, other specified	Administrative visits where referral was considered but not placed for unspecified reasons.
`Z76.89`	Persons encountering health services in other circumstances	Miscellaneous encounters where documentation that no referral occurred may be appropriate.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Often performed during the same visit when discussing advance care planning; a referral may be considered but `G0039` documents no referral occurred.
`99498`	Advance care planning, each additional 30 minutes	Used when ACP discussion extends beyond the first 30 minutes; may accompany documentation where no referral was made.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common primary care E/M visit during which the decision not to refer is documented and `G0039` may be reported.
`99406`	Smoking and tobacco use cessation counseling, intermediate, 3-10 minutes	Example of a preventive counseling service that might be performed in the same visit when a referral was considered but not placed.
`99407`	Smoking and tobacco use cessation counseling, intensive, >10 minutes	Used for longer counseling sessions that could occur in the same encounter documenting no referral.

OpenPayer