Summary & Overview
HCPCS G8973: Hemoglobin Level < 10 g/dl
HCPCS Level II code G8973 denotes a most recent hemoglobin (hgb) level below 10 g/dl and is used to record and report a clinically significant low hemoglobin result. This measure matters nationally because low hemoglobin is a common marker for anemia and can influence care pathways, quality metrics, and payment-related reporting across ambulatory and chronic care settings such as dialysis and primary care. Key payers included in coverage discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find an explanation of the clinical meaning and typical sites of service for G8973, an outline of payers commonly relevant to claims for low hemoglobin reporting, and an overview of the types of benchmarks and policy topics typically associated with hemoglobin reporting (quality measurement, care management flags, and lab-result–driven workflows). The publication also summarizes common billing modifiers and procedural contexts where G8973 may appear. Data not available in the input is noted where applicable. The content is intended for national audiences including billing professionals, compliance officers, and clinical program managers seeking concise guidance on the code’s purpose and operational context.
Billing Code Overview
HCPCS Level II code G8973 indicates a most recent hemoglobin (hgb) level < 10 g/dl. This code is used to document and report that a patient's latest laboratory hemoglobin measurement is below 10 grams per deciliter.
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Service type: Laboratory result reporting / clinical laboratory assessment
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Typical site of service: Outpatient clinics, dialysis centers, physician offices, and clinical laboratory settings
Clinical & Coding Specifications
Clinical Context
A 68-year-old female with chronic kidney disease stage 4 and anemia of chronic disease attends a routine nephrology clinic follow-up. Laboratory testing during the visit includes a complete blood count; the most recent hemoglobin returns at 9.2 g/dL. The clinic documents the result in the electronic health record, assesses for symptoms (fatigue, dyspnea on exertion), reviews iron studies and recent erythropoiesis-stimulating agent dosing, and updates the problem list and treatment plan. Billing staff assign the HCPCS Level II code G8973 to indicate that the patient’s most recent hemoglobin level is < 10 g/dL for quality reporting and payor notification. Typical workflow steps include obtaining the lab specimen (ambulatory clinic or outpatient laboratory), result verification by clinical staff, provider review and documentation, and coding/billing entry. Typical sites of service are outpatient clinic, dialysis center, and outpatient laboratory services. Common patient scenarios include anemia associated with chronic kidney disease, chemotherapy-induced anemia, and chronic inflammatory conditions where hemoglobin falls below 10 g/dL, prompting treatment evaluation or performance measure reporting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when services for evaluation or management relative to anemia required substantially greater work than usual and documentation supports increased complexity. |