HCPCS G9384: Documentation of Medical Exclusion from HCV Screening - OpenPayer

Summary & Overview

HCPCS G9384: Documentation of Medical Exclusion from HCV Screening

HCPCS Level II code G9384 denotes documentation of a medical reason for not receiving annual hepatitis C virus (HCV) screening. This code matters nationally because it standardizes capture of clinically justified exclusions from routine HCV screening, affecting preventive care reporting and quality measurement for populations with advanced liver disease, terminal illness, or transplant candidacy. Clear documentation supports care continuity and accurate quality metrics.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, common use cases (advanced liver disease, hepatocellular carcinoma, transplant waitlist, limited life expectancy), and the typical sites where documentation occurs. The publication outlines benchmarking and reporting implications, relevant billing considerations, and where G9384 intersects with quality measurement and preventive care workflows. It also summarizes common modifiers and payor considerations when available.

This summary is intended for national audiences including clinicians, coding and billing staff, quality leaders, and policy analysts seeking a concise reference on the purpose and reporting implications of HCPCS Level II code G9384. Data not available in the input is identified where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9384HCPCS Level IIHepatitis C screeningPreventive screening exclusionLiver disease documentationTransplant candidacyQuality reporting

Billing Code Overview

HCPCS Level II code G9384 documents a medical reason for not receiving annual screening for hepatitis C virus (HCV) infection. The code captures clinician-documented conditions that justify omission of routine HCV screening, such as decompensated cirrhosis with manifestations (ascites, esophageal variceal bleeding, hepatic encephalopathy), hepatocellular carcinoma, being on a waitlist for organ transplant, limited life expectancy, or other medical reasons.

Service type: Documentation of medical exclusion from preventive screening

Typical site of service: Inpatient and outpatient clinical settings where documentation of screening decisions is made, including hospitals, specialty hepatology clinics, transplant centers, and primary care clinics.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with known decompensated cirrhosis due to chronic hepatitis C is seen in hepatology clinic for routine follow-up. The patient has refractory ascites, prior esophageal variceal bleeding, and stage 3 hepatic encephalopathy with frequent hospitalizations. The clinician documents that annual HCV screening or repeat HCV RNA testing is medically inappropriate because the patient has advanced liver disease with limited life expectancy and is on the transplant waitlist with clear documentation that further HCV screening will not alter management. The documentation is entered into the medical record, signed by the attending hepatologist, and coded with G9384 to indicate the medical reason for not performing the annual HCV screening.

Workflow steps:

Initial evaluation identifies patient with advanced liver disease and prior HCV diagnosis or clear clinical indications that screening will not change care.
Clinician documents the specific medical reason(s) (e.g., decompensated cirrhosis with ascites, history of variceal bleed, hepatic encephalopathy, hepatocellular carcinoma, transplant waitlist status, or limited life expectancy).
Documentation is placed in the visit note and problem list, including supporting findings (imaging, MELD score, transplant status, prior HCC diagnosis).
Coding/billing staff assign G9384 on the claim to indicate documentation of medical reason(s) for not performing the annual HCV screening.
The claim is submitted to the relevant payor (e.g., Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare) with any applicable modifiers as needed for the encounter.

Coding Specifications

HCPCS G2201: Documentation of Medical Reason for Not Providing Brief Counseling

HCPCS-G8961-CARDIAC-STRESS-IMAGING-PREOPERATIVE-LOW-RISK

HCPCS G8961: Cardiac Stress Imaging for Preoperative Evaluation

HCPCS-G2252-VIRTUAL-CHECK-IN-11-20-MINUTE-ESTABLISHED-PATIENT

HCPCS G2252: Virtual Check-in for Established Patients, 11–20 Minutes

HCPCS-G0294-NONCOVERED-PROCEDURE-MEDICARE-CLINICAL-TRIAL-NO-ANESTHESIA

HCPCS G0294: Noncovered Procedure in Medicare Qualifying Clinical Trial, No/Local Anesthesia

HCPCS-G9678-OCM-MONTHLY-ENHANCED-ONCOLOGY-SERVICES

HCPCS G9678: Oncology Care Model Monthly Enhanced Oncology Services

HCPCS-G9926-SAFETY-CONCERNS-SCREENING-POSITIVE-NO-MITIGATION

HCPCS G9926: Safety Concerns Screening, Positive Without Mitigation Recommendations

HCPCS-G2198-MEDICAL-REASON-NO-UNHEALTHY-ALCOHOL-SCREENING

HCPCS G2198: Documentation of Medical Reason for Not Screening for Unhealthy Alcohol Use

HCPCS-G8700-REHABILITATION-SERVICES-NOT-INDICATED-AT-DISCHARGE

HCPCS G8700: Rehabilitation Services Not Indicated at Discharge

HCPCS-G0059-ANESTHESIA-PATIENT-SAFETY-MIPS-VALUE-PATHWAY

HCPCS G0059: Patient Safety and Positive Anesthesia Experience

HCPCS-G8501-PERIOPERATIVE-QUALITY-ACTIONS-COMPLETED

HCPCS G8501: Perioperative Care Quality Actions Completed

Showing 1–10 of 1996

Modifier	Description	When to Use
`22`	Increased procedural services	Use when services performed during the encounter required substantially greater effort or complexity and additional documentation supports increased work related to not performing screening.
`23`	Unusual anesthesia	Not typically used for this code; included for completeness when unrelated anesthesia circumstances affect the visit.
`52`	Reduced services	Use when the intended preventive service was partially performed or limited but not completed due to documented medical reasons.
`53`	Discontinued procedure	Use if the screening process was started but halted for a clear medical reason documented in the record.
`54`	Surgical care only	Rarely applicable; use when a surgical team documents medical reasons during a perioperative period affecting screening decisions.
`55`	Postoperative management only	Use if postoperative status is the clinical reason documented for not performing screening.
`56`	Preoperative management only	Use if preoperative assessment determines screening is not indicated and is documented as such.
`62`	Two surgeons	Use if two physicians of the same specialty jointly document and provide rationale influencing screening decisions.
`AS`	Ambulatory surgical center facility service	Use when the encounter generating the documentation occurs in an ambulatory surgical center setting.
`CQ`	Service provided by a resident without attending involvement under GME non-exempt rules	Use when a resident documents the medical reason and billing rules require the `CQ` modifier for that payor.
`FY`	Telementoring	Use if the documentation was supported by telementoring or remote specialist input relevant to the decision not to screen.
`QK`	Medical direction of two, three, or four assistants	Use rarely when assistant documentation affects the encounter rationale.
`QX`	Assistant clinician (PA/NP) billing under their own NPI	Use when an assistant clinician documents and the encounter requires indicating their involvement per payor rules.
`QY`	Attending physician of record (teleradiology/telemedicine)	Use when attending telemedicine documentation is the basis for the decision not to perform screening.

Taxonomy Code	Specialty	Notes
`207RH0000X`	Transplant Hepatology	Primary specialty documenting advanced liver disease and transplant-list status.
`207RC0000X`	Gastroenterology	Common specialty evaluating cirrhosis, variceal bleeding, and HCV management decisions.
`2080P0208X`	Infectious Disease	Specialty managing chronic HCV and assessing appropriateness of screening or treatment.
`207L00000X`	General Surgery (Transplant Surgery)	Involved when transplant waitlist status or perioperative issues drive screening decisions.
`163W00000X`	Palliative Medicine	May document limited life expectancy and goals-of-care decisions affecting preventive screening.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K74.60`	Unspecified cirrhosis of liver	Decompensated cirrhosis is a common medical reason to document that annual HCV screening will not change management.
`K72.90`	Hepatic failure, unspecified, without coma	Advanced liver failure supports medical justification for not performing routine HCV screening.
`I85.01`	Esophageal varices with bleeding	History of variceal bleeding indicates decompensated portal hypertension and advanced disease impacting screening decisions.
`R18.8`	Other ascites	Presence of ascites documents decompensation and limited benefit from routine screening.
`G93.40`	Encephalopathy, unspecified	Hepatic encephalopathy affects prognosis and may be cited as reason to defer screening.
`C22.0`	Liver cell carcinoma	Hepatocellular carcinoma is a listed medical reason for not performing screening when it will not alter management.
`Z94.4`	Liver transplant status	Being on a transplant waitlist or post-transplant status affects screening decisions and is explicitly referenced in the billing code description.
`Z66`	Do not resuscitate/limited life expectancy	Limited life expectancy or palliative status is a valid medical reason to document deferral of preventive screening.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	May be performed when documenting limited life expectancy or goals of care that influence the decision to forgo screening.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Common E/M code for clinic visits where `G9384` documentation is recorded during medical decision-making.
`36415`	Collection of venous blood by venipuncture	Performed when HCV testing is performed for other reasons; absence of this when screening is deferred is documented with `G9384`.
`87491`	Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C virus, with probe/primer detection, quantification	HCV RNA testing commonly associated with screening workflows; documentation of not performing this test is captured by `G9384`.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate	Example of an additional preventive counseling service often provided in clinic visits where screening decisions are documented.

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