HCPCS G2165: Influenza Vaccine Not Received During Measurement Period - OpenPayer

Summary & Overview

HCPCS G2165: Influenza Vaccine Not Received During Measurement Period

HCPCS Level II code G2165 documents that a patient did not receive an influenza vaccine during the measurement window (July 1 of the prior year through June 30 of the measurement period) and had no prior influenza vaccine adverse reaction. This designation is used in preventive care reporting and quality measurement to capture patients who remain unvaccinated for influenza within the specified reporting timeframe. The code matters nationally as influenza vaccination status is a common quality metric tied to population health efforts, preventive care performance measures, and payer reporting requirements.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on clinical interpretation of the code, typical sites of service where this code is relevant (primary care and ambulatory preventive settings), and what the code represents for quality measurement and reporting. Benchmarks, policy updates, and payer-specific reimbursement guidance are noted when available. Where specific data elements are not supplied in the input, the summary indicates that those items are not available. This summary is intended for a national audience seeking a concise reference on the clinical and reporting purpose of HCPCS Level II code G2165.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG2165HCPCS Level IIinfluenza vaccinationpreventive carequality measurementimmunization statusambulatory careprimary carevaccine reporting

Billing Code Overview

HCPCS Level II code G2165 indicates that a patient did not receive an influenza vaccine during the specified measurement window: on or between July 1 of the year prior to the measurement period and June 30 of the measurement period. The description also notes the patient did not have a prior influenza vaccine adverse reaction any time before or during the measurement period.

Service Type: Immunization status documentation / Preventive care reporting

Typical Site of Service: Primary care clinics, outpatient preventive care settings, and other ambulatory care sites where immunization status or preventive care measures are recorded

Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult primary care or family medicine patient presenting for a routine preventive visit during the influenza measurement period. The clinician reviews the patient’s immunization history and electronic health record between July 1 of the prior year and June 30 of the measurement period. The patient has no record of receiving the seasonal influenza vaccine in that timeframe and there is no documented history of a prior adverse reaction to an influenza vaccine. Clinical workflow: nurse or medical assistant performs vaccine history intake, clinician confirms lack of influenza vaccination and absence of vaccine allergy or prior adverse reaction, and the visit is coded accordingly. If no vaccine was administered and no contraindication or documented adverse reaction exists, the HCPCS Level II code G2165 is used for reporting the absence of influenza vaccination during the measurement period.

Coding Specifications

Modifier	Description	When to Use
`23`	Unusual Anesthesia	Use when anesthesia is administered under unusual circumstances unrelated to this preventive coding scenario (rare).
`52`

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

HCPCS-G9138-NON-HODGKINS-LYMPHOMA-DIAGNOSTIC-EVALUATION

HCPCS G9138: Non-Hodgkin's Lymphoma Diagnostic Evaluation

HCPCS-G9986-REMOTE-IN-HOME-EVALUATION-MANAGEMENT-ESTABLISHED-PATIENT

HCPCS G9986: Remote In-Home Evaluation and Management for Established Patients

HCPCS-G9741-HOSPICE-UTILIZATION-MEASURE

HCPCS G9741: Hospice Service Utilization Measure

HCPCS-G9326-CT-NOT-REPORTED-TO-DOSE-REGISTRY

HCPCS G9326: CT Studies Not Reported to Dose Index Registry

HCPCS-G2124-FRAILTY-AND-DEMENTIA-MEDICATION-66-80

HCPCS G2124: Frailty with Dispensed Dementia Medication, Ages 66–80

HCPCS-G9969-REFERRAL-REPORT-RECEIVED-BY-REFERRING-CLINICIAN

HCPCS G9969: Referral Report Received by Referring Clinician

HCPCS-G9174-SPEECH-LANGUAGE-PATHOLOGY-FUNCTIONAL-STATUS-ASSESSMENT

HCPCS G9174: Speech-Language Pathology Functional Status Assessment

HCPCS-G9632-URETER-INJURY-NOT-REPORTED-MEDICAL-REASONS

HCPCS G9632: Documented Medical Reasons for Not Reporting Ureter Injury

HCPCS-G8633-PHARMACOLOGIC-THERAPY-OSTEOPOROSIS-PRESCRIBED

HCPCS G8633: Pharmacologic Therapy for Osteoporosis Prescribed

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Most common specialty to document immunization status and preventive care.
`207R00000X`	Internal Medicine	Commonly provides adult preventive care and documents influenza vaccine status.
`208000000X`	Pediatrics	Documents pediatric influenza immunization status when applicable.
`163W00000X`	Nurse Practitioner	Frequently documents vaccine counseling and administration in primary care settings.
`363A00000X`	Physician Assistant	Commonly documents immunization status and administration in outpatient clinics.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90471`	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular); one vaccine	Performed when influenza vaccine is administered during the visit; documents vaccine administration that would negate use of `G2165`.
`90472`	Immunization administration, each additional vaccine (same visit)	Used if influenza vaccine is given along with additional vaccines at the same encounter; complementary to `90471`.
`90460`	Immunization administration through 18 years via any route of administration, with counseling by physician or other qualified health care professional; first or only component	Used for younger patients when counseling about vaccines occurs; documents counseling component when immunization is given.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common visit code for preventive or problem visits during which influenza vaccine status is reviewed and documented.
`G0008`	Administration of influenza virus vaccine, including counseling when performed, to Medicare beneficiaries in a physician’s office (separate payment)	Used specifically for reporting influenza vaccine administration to Medicare beneficiaries; presence of this code indicates vaccination occurred, contrasting with use of `G2165`.

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