Summary & Overview

HCPCS G9623: Documentation of Medical Reason Not to Screen for Unhealthy Alcohol Use

HCPCS Level II code G9623 denotes documentation of medical reasons for not performing screening for unhealthy alcohol use, such as limited life expectancy or other clinical contraindications. Nationally, this code matters because it records appropriate exceptions to a commonly recommended preventive screening, supports accurate quality measurement, and clarifies clinical intent in the medical record.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose and typical settings, expected payer coverage landscape, and what to expect in benchmarking and policy context where available. The publication outlines how G9623 interacts with quality reporting frameworks and documentation requirements, and highlights where data is available versus where input was not provided.

This summary provides clinicians, billing staff, and policy analysts with the clinical context and administrative framing needed to identify when G9623 is used, which payers commonly recognize it, and the types of analyses and updates readers can expect in the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9623HCPCS Level IIalcohol screening exceptionpreventive care documentationoutpatient servicesquality reportingclinical documentationscreening exception

Billing Code Overview

HCPCS Level II code G9623 documents the medical reason(s) for not screening for unhealthy alcohol use, for example when screening is not appropriate due to limited life expectancy or other medical reasons. The service type is clinical documentation of exception to preventive screening rather than an active screening procedure. The typical site of service for this code is outpatient clinical settings where preventive care decisions and charting occur, including primary care clinics, specialty clinics, and ambulatory care centers. If additional administrative or billing details are required, Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A primary care clinician documents that a patient was not screened for unhealthy alcohol use due to medical reasons. Typical patient: an 86-year-old man with advanced metastatic lung cancer receiving palliative care visits the outpatient oncology clinic accompanied by a family caregiver. The clinician reviews goals of care and determines that screening for unhealthy alcohol use is not clinically appropriate given limited life expectancy, severe cognitive impairment, and a focus on comfort measures. Documentation includes the specific medical reason(s) for not performing the screening, the clinical rationale, and the time/date and clinician signature in the electronic health record.

Workflow: At check-in, nursing staff flag preventive screening opportunities. During the clinician encounter, the provider assesses appropriateness of screening; if medically contraindicated or not relevant to the plan of care (for example, hospice enrollment, severe dementia, or terminal illness), the provider documents the medical reason(s) and checks the appropriate EHR quality measure exception. The visit charge entry includes the HCPCS Level II code G9623 to indicate documentation of medical reason(s) for not screening for unhealthy alcohol use. The record supports quality reporting and payor review with explicit rationale and, when required, related diagnoses and problem list entries.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when documentation supports substantially greater work than typical for the visit where `G9623` is reported in conjunction with E/M services and additional complexity is documented.
`23`	Unusual anesthesia	Rarely applicable; use only when anesthesia services were provided unexpectedly that affected the ability to screen.
`52`	Reduced services	Use when the screening service was partially performed but reduced or abbreviated due to patient condition and `G9623` documents the medical reason for incomplete screening.
`53`	Discontinued procedure	Use when screening was started but discontinued due to acute medical changes documented as the reason for not completing screening.
`54`	Surgical care only	Not typically applicable; include only when separate surgical team billing impacts concurrent preventive screening documentation.
`55`	Postoperative management only	Not typically applicable; use when postoperative status is the documented medical reason preventing screening.
`56`	Preoperative management only	Use when preoperative status or imminent surgery is the medical reason for deferring screening and is documented with `G9623`.
`62`	Two surgeons	Not commonly used for this service; include only in complex surgical cases where inability to screen is related to multi-surgeon operative care.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Not typically used for preventive screening exceptions; include only in the rare event surgical assistant billing coincides with screening documentation.
`CO`	Routine home care under hospice	Use when hospice enrollment and routine hospice care are the documented medical reasons for not screening.
`CQ`	Service furnished under a primary care exception by a clinical nurse specialist	Use when a clinical nurse specialist documents the medical reason for not screening under scope-of-practice rules.
`QK`	Medical direction of two, three, or four ancillary personnel	Include only if supervision arrangements affected the provision or documentation of screening in a way that aligns with billing rules.
`QX`	Ancillary personnel under physician supervision	Use when a qualified ancillary performed elements of the visit and the supervising physician documents the medical reason for not screening.
`QY`	Attending physician presence during teaching services	Use when teaching setting or supervision affected screening and was the documented reason for deferral.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary providers in outpatient settings who commonly document preventive screening exceptions.
`207R00000X`	Internal Medicine	Adult primary care physicians who assess appropriateness of alcohol screening in complex patients.
`208000000X`	General Practice	Providers in community clinics documenting preventive care exceptions.
`261QM0800X`	Clinical Nurse Specialist	Advanced practice providers who may document medical reasons for not screening.
`363LP0800X`	Palliative Medicine	Specialists frequently determining that screening is inappropriate in end-of-life care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z51.5`	Encounter for palliative care	Common justification for not screening due to focus on comfort and limited life expectancy.
`Z60.0`	Social environment issues, homeless	Social determinants that may affect appropriateness of screening and documentation of reason for deferral.
`F03.90`	Dementia, unspecified, without behavioral disturbance	Cognitive impairment making screening unreliable; documented reason for not performing screening.
`C34.90`	Malignant neoplasm of unspecified part of bronchus or lung, unspecified	Advanced malignancy as a medical reason for deferring preventive screening.
`Z51.89`	Encounter for other specified aftercare	Medical complexity or ongoing treatments that preclude screening at the encounter.
`R54`	Age-related physical debility	Frailty or limited life expectancy cited as reason for not screening.
`Z51.0`	Encounter for antineoplastic chemotherapy and immunotherapy	Active cancer treatment that may render screening inappropriate during that visit.
`Z99.89`	Dependence on other enabling machines and devices, not elsewhere classified	High-care needs that justify deferral of preventive screening.

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 E/M visit code during which the clinician documents the medical reason for not performing alcohol screening and reports `G9623` for quality reporting.
`99406`	Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Preventive counseling often bundled in primary care visits; documentation that other preventive interventions were considered may accompany `G9623` when alcohol screening is deferred.
`99408`	Alcohol and/or substance (other than tobacco) abuse structured screening and brief intervention services; 15 to 30 minutes	A related service that would be performed if screening were appropriate; `G9623` documents why such screening/intervention was not done.
`99409`	Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes	Higher-intensity brief intervention that is not performed when `G9623` is reported due to documented medical reasons.
`99304`	Initial nursing facility care, typically 30 minutes	In long-term care or hospice settings, this assessment code may accompany `G9623` when the facility-level evaluation documents medical reasons for deferring screening.