G9460 HCPCS: Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9460: Tobacco Assessment or Cessation Intervention Not Performed

HCPCS Level II code G9460 denotes that a tobacco assessment or tobacco cessation intervention was not performed and no reason was recorded. Nationally, accurate capture of care gaps and non-delivered preventive services has implications for quality reporting, population health management, and administrative records. This code provides a standardized way for clinicians and billing staff to indicate the absence of a tobacco-related clinical action in outpatient encounters.

Key payers in the framework for this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what G9460 represents clinically and operationally, how payers commonly treat documentation of non-performed tobacco services, and what this means for quality measurement and recordkeeping. The publication also outlines common use cases, reporting considerations, and related billing context to inform coding staff, compliance teams, and administrators.

The content covers benchmarks and policy-relevant context where available, practical implications for electronic health record documentation and claim submission, and a summary of areas where additional data or payer-specific guidance may be required. Data not available in the input is noted where appropriate.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9460HCPCS Level IItobacco cessationpreventive servicesbilling documentationoutpatientquality reportingmedical coding

Billing Code Overview

HCPCS Level II code G9460 indicates tobacco assessment or tobacco cessation intervention not performed, reason not given. The service type represented by this code is documentation of a tobacco-related clinical activity that was not completed, specifically noting that a tobacco assessment or cessation intervention did not occur and no reason was provided. The typical site of service for use of this code is ambulatory or outpatient clinical settings where tobacco screening and cessation counseling are normally performed, such as primary care clinics, specialty outpatient visits, and community health centers.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 52-year-old primary care patient presents for an annual wellness visit at an outpatient clinic. The clinician documents vital signs and updates the social history. The medical assistant asks about tobacco use, but the patient declines to discuss tobacco at this visit and no tobacco assessment or counseling is performed. The clinician records that tobacco assessment or tobacco cessation intervention was not performed, reason not given, and links the encounter to billing code G9460. Typical workflow: check-in and vitals by staff, rooming interview includes standard preventive screening prompts (including tobacco), patient declines or assessment is omitted without documentation of reason, provider documents refusal or omission in the chart and selects G9460 for reporting that the tobacco assessment/intervention was not performed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when additional work beyond the usual is documented for the visit unrelated to tobacco intervention omission (rarely applicable to `G9460`).

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Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly document tobacco assessment or reasons for omission.
`207R00000X`	Internal Medicine	Internal medicine physicians frequently manage preventive screenings and document tobacco interventions.
`208D00000X`	Pediatrics	Pediatricians screen adolescent patients for tobacco use and may document omission for younger patients.
`2086S0122X`	Preventive Medicine	Preventive medicine specialists perform systematic tobacco screening and cessation services.
`363L00000X`	Health Education/Behavioral Health Counselor	Clinicians providing cessation counseling or documenting omission when counseling not delivered.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z72.0`	Tobacco use	Directly indicates tobacco use; often prompts assessment and cessation interventions that `G9460` would note were not performed.
`F17.200`	Nicotine dependence, unspecified, uncomplicated	Common diagnosis for patients who may require cessation counseling; relevant to documentation when counseling is omitted.
`Z87.891`	Personal history of nicotine dependence	Used for patients with prior nicotine dependence; tobacco screening remains relevant and omission is documented with `G9460`.
`R07.9`	Chest pain, unspecified	Symptom-driven visits (e.g., chest pain) where tobacco assessment might be expected but not performed; `G9460` may be reported.
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Preventive visits where tobacco screening is standard; `G9460` documents that assessment was not performed.
`Z13.89`	Encounter for other specified screening	General screening code category; tobacco screening falls under routine screening expectations and omission is reported with `G9460`.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common outpatient E/M code where tobacco assessment or counseling would normally occur; `G9460` documents that tobacco intervention was not performed during such a visit.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Counseling code that would be billed when tobacco cessation intervention is performed; absence of this service may be why `G9460` is reported.
`99407`	Smoking and tobacco use cessation counseling visit, intensive, greater than 10 minutes	Used when more intensive cessation counseling is provided; `G9460` indicates such counseling was not performed.
`G0438`	Annual wellness visit, initial, includes a personalized prevention plan of service (PPPS)	Tobacco assessment is a component of annual wellness visits; `G9460` may be used if tobacco assessment not performed during this preventive encounter.
`G0439`	Annual wellness visit, subsequent, includes a personalized prevention plan of service (PPPS)	Similar to `G0438`; `G9460` documents omission of tobacco screening/counseling on follow-up wellness visits.

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