G2022 HCPCS Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G2022: Ambulance Response - Beneficiary Refuses Transport or Treatment

HCPCS Level II code G2022 documents instances when an ambulance supplier or provider responds to a beneficiary but the beneficiary refuses covered services, such as transport to an alternate destination or treatment in place. Nationally, clear identification of refusal events matters for patient safety documentation, claims processing, and program evaluation for emergency medical services models. This code codifies the encounter when services were offered but not accepted.

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 and administrative context, guidance on typical use cases in prehospital care, and summaries of how major payers treat refusal documentation in claims processing where available. The publication also highlights common modifiers associated with ambulance service reporting and notes when input data are not available.

The report is written for a national audience and focuses on the operational and billing implications of documenting patient refusals in ambulance encounters, including benchmarking considerations and policy-relevant factors affecting adjudication and program measurement.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG2022HCPCS Level IIambulancepatient refusalprehospital careemergency medical servicestransport refusalclaims documentation

Billing Code Overview

HCPCS Level II code G2022 describes a situation in which a model participant ambulance supplier or provider attempts to furnish covered services but the beneficiary refuses the services. The service type is emergency medical transport response with refusal of transport to an alternate destination or refusal of treatment in place. The typical site of service is the prehospital setting, including the scene of an emergency or other location where ambulance personnel respond to a beneficiary and the beneficiary declines transport or treatment.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical encounter involves an emergency medical services (EMS) response where a beneficiary is evaluated by an ambulance crew participating in an alternative destination/treatment-in-place model. For example, paramedics respond to a 72-year-old male with dizziness and mild confusion. After on-scene assessment, the crew proposes transport to an urgent care or observation unit as an alternate destination or recommends treatment in place (e.g., IV fluids, glucose correction, cardiac monitor) instead of transport to the emergency department. The beneficiary understands options but explicitly refuses any transport or treatment beyond basic on-scene assessment. The crew documents the beneficiary’s informed refusal, clinical assessment, vitals, capacity to refuse, and any refusal forms. Billing uses G2022 to indicate the model participant attempted to provide model-covered services but the beneficiary refused services (transport to an alternate destination or treatment in place). Typical workflow includes on-scene assessment, offering alternatives, obtaining refusal documentation, notifying medical control if required, and completing the ambulance run report with G2022 appended as appropriate to claim submission.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

HCPCS G0519: Management of New Patient-Caregiver Dyad with Dementia, Low Complexity

HCPCS-G2092-ACE-ARB-ARNI-THERAPY-PRESCRIBED-OR-TAKING

HCPCS G2092: ACE/ARB/ARNI Therapy Prescribed or Currently Taken

HCPCS-G0311-IMMUNIZATION-COUNSELING-NO-VACCINE-16-30-MINS

HCPCS G0311: Immunization Counseling When Vaccine Not Administered, 16–30 mins

HCPCS-G9204-HEPATITIS-C-RNA-TESTING-NOT-DOCUMENTED

HCPCS G9204: Hepatitis C RNA Testing Not Documented Within 12 Months

HCPCS-G2088-OFFICE-BASED-OPIOID-USE-DISORDER-THERAPY-ADDL-30-MIN

HCPCS G2088: Office-Based Opioid Use Disorder Treatment, Additional 30 Minutes

HCPCS-G9357-POSTPARTUM-SCREENING-EVALUATION-EDUCATION

HCPCS G9357: Postpartum Screenings, Evaluations, and Education

HCPCS-G0492-DIALYSIS-EVALUATION-ACUTE-KIDNEY-INJURY

HCPCS G0492: Dialysis Evaluation for Acute Kidney Injury

HCPCS-G9745-DOCUMENTED-REASON-NO-BP-SCREENING-OR-FOLLOW-UP

HCPCS G9745: Documented Reason for Not Screening or Recommending Follow-Up for High Blood Pressure

HCPCS-G9271-LDL-UNDER-100

HCPCS G9271: LDL Cholesterol Value < 100

HCPCS-G0434-DRUG-SCREEN-NON-CHROMATOGRAPHIC-MULTICLASS

HCPCS G0434: Non-Chromatographic Multiclass Drug Screen

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`311500000X`	Emergency Medical Technician-Paramedic (EMT-P)	Primary providers performing on-scene assessment and treatment in the ambulance model.
`208D00000X`	Emergency Medicine Physician	Medical control and destination medical oversight for alternate destination decisions.
`363A00000X`	Ambulance Service (Ground)	Organizational taxonomy for ground ambulance suppliers/providers participating in the model.
`367500000X`	Clinical Nurse Specialist	Advanced practice clinicians who may provide or supervise treatment-in-place under some models.
`208000000X`	Family Medicine Physician	May provide medical direction or accept patients at alternate destinations such as urgent care or observation units.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R42`	Dizziness and giddiness	Common complaint leading to EMS response; alternatives to ED transport or treatment in place may be offered and refused.
`R41.0`	Disorientation, unspecified	Altered mental status prompting assessment and possible alternate destination; refusal requires capacity documentation.
`R55`	Syncope and collapse	Frequent EMS activation reason where transport to an alternate destination or observation may be considered before refusal.
`E11.9`	Type 2 diabetes mellitus without complications	Hypoglycemia or hyperglycemia episodes may be treated on scene (e.g., glucose) and patient may refuse transport after stabilization.
`I63.9`	Cerebral infarction, unspecified	Stroke symptoms often prompt EMS; if sensory/mild symptoms and patient refuses further care, documentation is critical.
`J02.9`	Acute pharyngitis, unspecified	Lower-acuity complaints sometimes eligible for alternate destinations; patient refusal of transport or treatment is billed with `G2022`.
`S09.90XA`	Unspecified injury of head, initial encounter	Minor head injury may be managed with observation or alternate destination; refusal of recommended transport captured by `G2022`.
`T78.40XA`	Allergy, unspecified, initial encounter	Allergic reactions treated on scene (e.g., antihistamines, epinephrine) where patient subsequently refuses transport.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99281`	Emergency department visit, problem-focused	Represents a low-complexity ED visit that a beneficiary might avoid by accepting alternate destination; relevant for comparing levels of subsequent care.
`99282`	Emergency department visit, expanded problem-focused	Represents a moderate-complexity ED visit; used to describe expected services if transport to ED had occurred instead of refusal.
`99285`	Emergency department visit, high severity	Represents high-complexity ED care that might be necessary if the beneficiary’s condition deteriorates after refusal; documents potential resource needs.
`94640`	Inhalation treatment for acute airway obstruction	Example of on-scene treatment-in-place that could be provided under the model prior to transport refusal.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance)	On-scene medication administration (e.g., epinephrine, glucose) that may occur when care is initiated before a beneficiary refuses further services.
`99051`	Services provided between 10 PM and 6 AM	Use when on-scene assessment and refusal occurred during late-night hours and payer policies require time-of-service modifiers for claims processing.

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