Summary & Overview
HCPCS G8458: Documentation of Ineligibility for Hepatitis C Genotype Testing
HCPCS Level II code G8458 documents that a clinician has recorded a patient as not being an eligible candidate for hepatitis C genotype testing and that the patient was not receiving antiviral treatment during the measurement period. This code captures exceptions to standard genotype-testing measures—such as prior testing outside the reporting window, patient refusal, or clinical ineligibility—and supports performance reporting and quality measurement workflows nationally.
Key payers referenced in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical intent, typical service settings, and how it fits into measure reporting for hepatitis C care. The publication outlines benchmarks and reporting implications where available, summarizes relevant policy and quality-measure context affecting national reporting, and describes the clinical situations that commonly prompt use of this code.
This summary provides clinicians, billing staff, and compliance teams with the essential background needed to identify when G8458 is applicable in outpatient care and quality documentation. Data not available in the input will be noted in detail sections.
Billing Code Overview
HCPCS Level II code G8458 documents that a clinician determined a patient is not an eligible candidate for genotype testing and that the patient was not receiving antiviral treatment for hepatitis C during the measurement period. Examples in the description include scenarios such as a genotype test performed prior to the reporting period, a patient declining testing, or clinical determination that the patient is not a candidate for antiviral therapy.
Service type: Clinical documentation / quality-measure reporting for hepatitis C management, centered on documenting eligibility and treatment status for genotype testing and antiviral therapy.
Typical site of service: Outpatient clinical settings, including primary care clinics, infectious disease clinics, and specialty hepatology or gastroenterology practices where hepatitis C testing and treatment decisions are made.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of chronic hepatitis C is seen in an outpatient hepatology clinic during the measurement period. The clinician reviews prior records and documents that the patient previously had HCV genotype testing performed in 2018, and there is no clinical indication to repeat genotype testing now. Alternatively, the patient may be medically ineligible for antiviral therapy due to advanced comorbidities (for example, active malignancy receiving cytotoxic chemotherapy), or the patient may decline treatment after shared decision-making. The clinician documents that the patient is not an eligible candidate for genotype testing and that the patient is not receiving antiviral treatment during the measurement period. This documentation is used to report quality and population health measures and supports billing using the HCPCS Level II code G8458. Typical workflow steps include chart review of prior genotype results, assessment of treatment eligibility, documentation of contraindications or patient refusal in the medical record, and coding/billing staff applying G8458 for the reporting period.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure | Use when a distinct E/M visit is performed in addition to services related to hepatitis C management on the same date |