HCPCS G9296: Shared Decision-Making Including Conservative Therapy Discussion - OpenPayer

Summary & Overview

HCPCS G9296: Shared Decision-Making Including Conservative Therapy Discussion

HCPCS Level II code G9296 denotes documentation that a patient engaged in shared decision-making which included discussion of conservative (non-surgical) therapies—such as NSAIDs, analgesics, weight loss, exercise, and injections—prior to undergoing a procedure. Nationally, explicit documentation of pre-procedure conservative care conversations is increasingly emphasized by payers and health systems as part of efforts to optimize patient-centered care, reduce unnecessary interventions, and align care with evidence-based conservative management.

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 clinical intent and typical settings, an outline of payer coverage considerations, and context on how G9296 is used to record shared decision-making around non-surgical options. The publication also summarizes common modifiers associated with the service and notes where input data is unavailable.

This summary provides operational clarity for billing and compliance teams, clinical documentation specialists, and policy analysts seeking a national perspective on recording pre-procedure conservative therapy discussions. Data not available in the input includes payer-specific reimbursement rates and detailed ICD-10 pairings.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9296HCPCS Level IIshared decision-makingconservative therapypreoperative counselingoutpatientdocumentationpre-procedure

Billing Code Overview

HCPCS Level II code G9296 documents that a patient had a shared decision-making discussion prior to a procedure that included consideration of conservative (non-surgical) therapies. The description specifies discussion of options such as nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, weight loss, exercise, and injections as alternatives or adjuncts to surgery.

Service type: Pre-procedure shared decision-making / conservative therapy counseling

Typical site of service: Outpatient clinic, preoperative consultation, or office-based surgical evaluation

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

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient with chronic knee osteoarthritis presents to an orthopedic surgeon for surgical consideration after conservative measures in primary care provided insufficient relief. The surgeon documents a shared decision-making discussion that reviewed non-surgical options including activity modification, weight loss, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, topical analgesics, intra-articular corticosteroid or hyaluronic acid injections, and bracing. The patient’s pain, functional limitations, and imaging findings are reviewed; the clinician documents that conservative therapy was attempted and the patient either had inadequate response or prefers surgery after understanding risks and benefits. The shared decision-making conversation is recorded in the preoperative note, including alternatives, expected outcomes, and patient preference.

Typical workflow:

Referral from primary care or pain management with prior conservative therapy documented.
Preoperative clinic visit where the surgeon performs history and exam, reviews prior non-surgical treatments, discusses alternatives, and documents shared decision-making.
Preauthorization or billing staff attach G9296 to the surgical episode to indicate documented shared decision-making and prior conservative therapy discussion, when payer policy requires such attestation.

Typical site of service: ambulatory surgical center or hospital outpatient clinic for preoperative evaluation and surgical procedure scheduling.

Coding Specifications

HCPCS G9947: Leg Pain VAS Preoperative and Postoperative Measurement

HCPCS-G9209-HEPATITIS-C-QUANTITATIVE-RNA-4-12-WEEKS-AFTER-TREATMENT-START

HCPCS G9209: Hepatitis C Quantitative RNA Testing 4–12 Weeks After Treatment Start

HCPCS-G8696-ANTITHROMBOTIC-THERAPY-PRESCRIBED-AT-DISCHARGE

HCPCS G8696: Antithrombotic Therapy Prescribed at Discharge

HCPCS-G8427-MEDICATION-RECONCILIATION-REVIEW

HCPCS G8427: Clinician Attestation of Medication Review

HCPCS-G8863-PATIENT-NOT-ASSESSED-BONE-LOSS

HCPCS G8863: Patients Not Assessed for Risk of Bone Loss

HCPCS-G9214-CD4-CELL-COUNT-OR-PERCENTAGE-RESULTS-DOCUMENTED

HCPCS G9214: CD4+ Cell Count or Percentage Results Documented

HCPCS-G9634-QUALITY-OF-LIFE-ASSESSMENT-MULTIPLE-VISITS-STABLE-IMPROVED

HCPCS G9634: Health-Related Quality of Life Assessment, Repeat Visits

HCPCS-G9005-COORDINATED-CARE-FEE-RISK-ADJUSTED-MAINTENANCE

HCPCS G9005: Coordinated Care Fee, Risk-Adjusted Maintenance

HCPCS-G9103-GASTRIC-CANCER-ADENOCARCINOMA-METASTATIC-DISEASE-STATUS

HCPCS G9103: Gastric Cancer Adenocarcinoma, Metastatic Disease Status

HCPCS-G9202-HEPATITIS-C-ANTIBODY-POSITIVE

HCPCS G9202: Positive Hepatitis C Antibody Test

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207L00000X`	Orthopaedic Surgery	Primary specialty performing joint replacement and related surgical procedures.
`208U00000X`	Physical Medicine & Rehabilitation	Often involved in non-surgical management, prehab, and postoperative rehabilitation planning.
`207R00000X`	Sports Medicine (Orthopedic)	Manages conservative therapies and surgical decision-making for joint pathology.
`207P00000X`	Pain Medicine (Anesthesiology)	Provides injections, medication management, and procedural pain care discussed during shared decision-making.
`363A00000X`	Nurse Practitioner	May conduct preoperative evaluations and document shared decision-making under supervising clinician.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M17.11`	Unilateral primary osteoarthritis, right knee	Knee osteoarthritis is a common indication for discussing conservative therapies prior to knee arthroplasty.
`M17.12`	Unilateral primary osteoarthritis, left knee	Same clinical relevance for left knee disease.
`M16.11`	Unilateral primary osteoarthritis, right hip	Hip osteoarthritis typically prompts discussion of non-surgical options before hip replacement.
`M16.12`	Unilateral primary osteoarthritis, left hip	Left hip osteoarthritis relevance as above.
`M25.50`	Pain in joint, unspecified site	Joint pain documentation supports the need to review conservative management options.
`M54.5`	Low back pain	Chronic low back pain may be managed conservatively and discussed in shared decision-making prior to spine procedures.
`M51.26`	Other intervertebral disc displacement, lumbar region	Disc pathology where injections and conservative measures are considered prior to surgical intervention.
`M19.071`	Primary osteoarthritis, right shoulder	Shoulder osteoarthritis where non-surgical treatments are commonly attempted prior to arthroplasty.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee)	Represents conservative intra-articular injection therapy discussed during shared decision-making and often attempted prior to surgery.
`97110`	Therapeutic exercises to develop strength and endurance, range of motion and flexibility	Common conservative therapy (physical therapy) trial discussed and prescribed before considering surgical intervention.
`99243`	Office consultation for a new or established patient, typically 40 minutes	Example of a preoperative consultation visit where shared decision-making and conservative therapy documentation may be recorded. (Note: actual consultation codes vary by visit length and payer rules.)
`27130`	Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty)	Example of a definitive surgical procedure for which `G9296` may be appended to attest prior conservative therapy discussion when required by payer policy.
`27447`	Arthroplasty, knee, condyle and plateau; medial and lateral compartment with or without patellar resurfacing (total knee arthroplasty)	Example of a definitive surgical procedure where documentation of prior conservative therapy and shared decision-making is relevant for preauthorization and billing.

`22`	Increased procedural services	Use when services require substantially greater work than typically required and supporting documentation explains the increased work.
`23`	Unusual anesthesia	Use when general anesthesia is administered for a procedure usually performed with local or no anesthesia.
`52`	Reduced services	Use when a service is partially reduced or not completed and documentation explains the reduction.
`53`	Discontinued procedure	Use when a procedure is started but discontinued for reasons not related to patient tolerance.
`54`	Surgical care only	Use when billing only the surgeon’s portion of a global surgical package.
`55`	Postoperative management only	Use when billing only postoperative care separate from the procedure.
`56`	Preoperative management only	Use when billing only preoperative evaluation and management that is separate from the global package.
`62`	Two surgeons	Use when two surgeons perform distinct portions of a procedure and documentation supports co-surgery.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an assistant-at-surgery role is performed by an advanced practice clinician and payer permits billing.
`QK`	Medical direction of two, three, or four concurrent anesthetists by a physician	Use when the physician medically directs multiple certified registered nurse anesthetists (CRNAs).
`QX`	CRNA service: CRNA with medical direction by a physician	Use when CRNA provides service under physician direction.
`QY`	Medical direction of one CRNA by an anesthesiologist	Use when an anesthesiologist medically directs one CRNA.

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