Summary & Overview
HCPCS G9386: Screening for HCV Infection Not Received Within 12-Month Period
HCPCS Level II code G9386 captures instances where a patient did not receive hepatitis C virus (HCV) screening within the 12-month reporting period and no reason was recorded. As a quality-reporting marker, the code helps payers and providers identify gaps in preventive care tracking for HCV screening, which is a nationally relevant public health priority given rising HCV incidence and treatment advances.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, the clinical and reporting context for HCV screening omissions, and what analyses typically accompany such a code: benchmarking against payer expectations, interpretation in quality measurement programs, and implications for preventive care workflows.
The publication outlines how G9386 is used in administrative reporting, common sites of service where the code appears, and the kinds of benchmarks and policy updates that organizations track in relation to HCV screening rates. Data not available in the input will be noted where relevant. The focus is national in scope and aimed at stakeholders who manage quality measurement, compliance, and preventive care reporting.
Billing Code Overview
HCPCS Level II code G9386 denotes screening for HCV infection not received within the 12 month reporting period, reason not given. This code is used to indicate that a patient did not receive hepatitis C virus (HCV) screening during the specified 12-month reporting period and that no reason for the absence of screening was provided.
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Service type: Preventive screening omission tracking
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Typical site of service: Ambulatory care settings, including primary care clinics and outpatient preventive care visits
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 45-year-old primary care patient with risk factors for hepatitis C virus (HCV) infection (history of prior injection drug use in the 1990s and prior incarceration) presents for an annual wellness visit. The clinician documents that HCV screening was not performed within the 12-month reporting period and no reason is recorded in the chart. Clinic workflow: during rooming, nursing reviews preventive care due items and notes HCV screening status. The clinician confirms that screening was not completed and documents the discussion of HCV screening and counseling. No laboratory specimen was collected during the visit. This situation triggers reporting of the HCPCS Level II code G9386 to indicate “Screening for HCV infection not received within the 12 month reporting period, reason not given.” Typical site of service is an outpatient clinic or physician office during a preventive or chronic care visit. The typical patient scenario includes eligible adults recommended for HCV screening who decline, have no labs drawn, or where the service was not completed and no clinical reason is documented.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Rarely applicable; use only if additional, documentable work was performed related to counseling or extended visit beyond typical screening discussion. |