Summary & Overview
HCPCS G9726: Patient Refused to Participate
HCPCS Level II code G9726 denotes a documented patient refusal to participate in a recommended clinical service or program. Nationally, explicit capture of refusals supports accurate clinical records, quality reporting and claims adjudication by distinguishing patient-driven non‑completion from provider-initiated or system-related care gaps. The code applies across ambulatory and outpatient settings, where documenting refusal has implications for quality measurement and potential payer follow-up.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise primer on what G9726 represents, why explicit refusal documentation matters for billing and quality workflows, and what to expect in payer coverage context. The publication summarizes common use cases, reporting implications for quality programs, and the operational considerations clinics should track when a patient declines a service.
This national overview covers benchmarks and reporting considerations, recent policy updates affecting refusal documentation, and clinical context that clarifies when G9726 is appropriate to use. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code G9726 indicates Patient refused to participate. This code is used to document that a patient declined to engage in a recommended service or program. The service type is patient refusal of a recommended clinical service or activity, and the typical site of service is the outpatient or ambulatory setting where such refusals are recorded, including clinics, physician offices, and outpatient departments.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient presents for a scheduled behavioral health screening or quality measure assessment (for example, an annual depression screening, tobacco cessation counseling offer, or substance-use screening) during a primary care or outpatient behavioral health visit. The clinician explains the screening or counseling process and obtains verbal consent to proceed with the standardized tool or intervention. The patient explicitly declines to participate in the screening or refuses counseling when offered. The care team documents the refusal in the medical record, including the date, the service offered, the reason for refusal when provided by the patient, and evidence that the patient was informed about potential benefits and alternatives. Typical workflow includes: triage or rooming staff noting the offer and refusal; the clinician confirming and documenting the refusal in the encounter note; and coding/billing staff assigning billing code G9726 to indicate that the patient refused to participate in the specified quality measure activity. Typical sites of service are outpatient primary care clinics, behavioral health clinics, ambulatory surgery centers where preoperative screening is offered, and community health centers.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When the service required substantially greater work than typical (rarely applicable to a refusal code) |