G9385 HCPCS: Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9385: Documentation of Patient Reason for Not Receiving Annual HCV Screening

HCPCS Level II code G9385 records documented patient reasons for not receiving the annual screening for hepatitis C virus infection, such as an explicit patient refusal. Nationally, capturing refusal or patient-reported barriers to preventive services is important for quality measurement, care coordination, and accurate administrative reporting. This administrative code supports consistent documentation of patient choice and can affect preventive care metrics and performance reporting.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's purpose, typical service settings, and implications for documentation and reporting. The publication summarizes common modifiers associated with outpatient documentation workflows, notes where information is not provided, and outlines the clinical context of annual HCV screening and why documentation of refusal is recorded separately from provision of the test.

The piece does not provide clinical recommendations. It supplies benchmarks and policy-oriented context where available, describes typical coding practice and service lines for G9385, and identifies which data elements are missing from the input (for example, associated taxonomies, ICD-10 diagnoses, and related codes). This national-level summary is intended to inform coding, compliance, and administrative teams about the role of G9385 in documenting non-receipt of HCV screening.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9385HCPCS Level IIHCV screeningpreventive caredocumentationpatient refusaloutpatientquality measurement

Billing Code Overview

HCPCS Level II code G9385 documents the patient-stated reason(s) for not receiving the annual screening for hepatitis C virus (HCV) infection (for example, patient declined or other patient reasons). This code captures the clinical and administrative record that a patient did not undergo the recommended annual HCV screening and the documented rationale.

Service type: Documentation of patient refusal or patient reason for non-receipt of preventive screening
Typical site of service: Outpatient ambulatory settings, primary care clinics, community health centers, and other outpatient encounters where preventive screening is offered

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient presents to a primary care clinic for an annual preventive visit. The clinician discusses routine screening recommendations, including annual hepatitis C virus (HCV) screening for at-risk adults and adults born 1945–1965 or per updated guidelines. The patient declines HCV testing after counseling, citing personal preference and concerns about blood draws. The clinician documents the patient’s reason for declining and the counseling provided in the medical record and captures the service using billing code G9385 for documentation of patient reason(s) for not receiving annual screening for HCV infection. Typical workflow: during the visit the clinician offers testing, provides brief counseling, records the patient’s refusal and rationale in the chart, and applies G9385 on the claim to reflect documented refusal; any applicable visit or preventive service CPT codes remain reported separately as appropriate.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documentation supports substantially greater work or complexity for counseling or documentation related to HCV screening refusal during the visit.

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HCPCS-G9847-SYSTEMIC-CANCER-THERAPY-LAST-14-DAYS-LIFE

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HCPCS-G9900-MAMMOGRAPHY-RESULTS-NOT-DOCUMENTED-REVIEWED

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Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians who routinely offer and document HCV screening and refusals.
`207R00000X`	Internal Medicine	Internists providing preventive services and documenting reasons for refusal.
`208000000X`	Pediatrics	Pediatricians documenting caregiver refusal of HCV screening for adolescents when applicable.
`208D00000X`	Obstetrics & Gynecology	OB/GYN clinicians offering routine screening during annual or prenatal visits.
`283Q00000X`	Infectious Disease	Specialists who may document patient refusal for targeted screening in specialty clinics.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z71.89`	Other specified counseling	Used when counseling about HCV screening is provided and refusal is documented; supports documentation of counseling.
`Z20.9`	Contact with and (suspected) exposure to unspecified communicable disease	May be used when exposure risk is discussed; helps justify offering HCV screening prior to documented refusal.
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Common preventive visit code during which HCV screening is offered and may be declined; `G9385` documents refusal.
`Z34.90`	Encounter for supervision of normal pregnancy, unspecified, unspecified trimester	During prenatal care HCV screening is routinely offered; if declined, documentation can be reported with `G9385`.
`Z77.21`	Contact with and (suspected) exposure to environmental tobacco smoke	Example of a counseling-related code; not specific to HCV but may co-occur in preventive counseling visits.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99381`	Initial comprehensive preventive medicine evaluation, new patient; infant (age specific)	May be the visit code used when initial preventive services are provided and HCV screening is discussed but declined; `G9385` documents the refusal.
`99397`	Periodic comprehensive preventive medicine reevaluation, established patient; 65 years and older	Example periodic preventive visit for established patients where HCV screening is reviewed and may be declined; `G9385` documents refusal.
`99401`	Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (15 minutes)	If separate preventive counseling about HCV risk is billed, `G9385` documents patient refusal of the screening test itself.
`36415`	Collection of venous blood by venipuncture	Commonly performed when HCV screening is accepted; if the patient declines, `G9385` documents the reason for not performing this collection.
`86803`	Hepatitis C antibody; laboratory test (may be reported by the performing lab)	The actual HCV antibody test performed when accepted; `G9385` is used when the test is not done due to documented patient refusal.

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