Summary & Overview
HCPCS G9399: Genotype-Informed Treatment Counseling
HCPCS Level II code G9399 represents documentation of a clinician–patient discussion that addresses genotype-based treatment options, associated risks and benefits, evidence of effectiveness, and the patient’s preferences. As genomic medicine and precision therapeutics expand, documenting these conversations supports clinical decision-making, continuity of care, and administrative tracking of genotype-informed counseling.
Key payers included in this national overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what G9399 denotes clinically and operationally, how it is used in ambulatory and specialty settings, and what to expect when aligning documentation with payers’ coverage policies. The publication summarizes common modifiers associated with this service and highlights typical sites of service where genotype-informed counseling occurs.
This piece provides practical context for health system coders, clinical leaders, and compliance staff: clarifying the code’s purpose, outlining documentation elements embedded in the code description, and identifying gaps where input data was not available. The goal is to enable accurate coding and recordkeeping for genotype-related shared decision-making encounters at a national level.
Billing Code Overview
HCPCS Level II code G9399 documents when a physician or clinician records a discussion with a patient that covers treatment choices appropriate to genotype, risks and benefits, evidence of effectiveness, and patient preferences toward the outcome of the treatment. This entry captures informed, documented shared-decision conversations tied to genotype-informed care.
Service type: Genotype-informed treatment counseling and shared decision-making
Typical site of service: Outpatient clinic, specialty/genetics consultation, or other ambulatory care settings
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient with metastatic non–small cell lung cancer (NSCLC) presents for a counseling visit after tumor genotyping identified an actionable EGFR mutation. The treating oncologist reviews targeted therapy options, discussing treatment choices appropriate to the genotype, risks and benefits of each option, evidence of effectiveness from clinical trials and real-world data, and elicits the patient’s preferences and goals for therapy, documenting the shared decision-making conversation in the medical record. The clinical workflow includes review of molecular testing results, preparation of patient education materials, a face-to-face or telehealth counseling session lasting enough time to cover alternatives and risks, documentation that the patient’s values and preferences were considered, and recording of the final treatment decision. Typical clinicians documenting this discussion include oncologists, genetic counselors, and advanced practice providers. The typical site of service is an outpatient oncology clinic or telemedicine visit, with possible documentation in the electronic health record (EHR) and inclusion in the problem list and treatment plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the counseling required substantially greater work than typical and documentation supports increased complexity. |