G9728 Patient Refused to Participate HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS Level II G9728: Patient Refused to Participate

HCPCS Level II code G9728 documents instances where a patient explicitly refuses to participate in a recommended service or program. Nationally, clear documentation of patient refusals matters for clinical records, quality measurement, and billing integrity. Use of G9728 signals that care was offered but not received due to patient choice, which can affect quality metrics and administrative reporting.

Key payers considered in this context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical meaning, guidance on typical settings where it is applied, and an overview of how it is handled across major payers. The publication provides benchmarks where available, notes on payer coverage approaches, and the clinical context for documenting refusals to ensure accurate claims and records.

This summary is written for a national audience and focuses on practical implications of documenting patient refusal, reporting considerations, and common themes in payer treatment of such service-line events. Data not available in the input where specifics are required.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9728HCPCS Level IIpatient refusalrefusal of caredocumentationquality measurementoutpatient servicesbilling

Billing Code Overview

HCPCS Level II code G9728 denotes 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 refusal of care/participation, and the typical site of service is the clinical or outpatient setting where the recommendation was made, such as a physician office, clinic, or outpatient department.

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Clinical & Coding Specifications

Clinical Context

A patient presents to an outpatient primary care clinic or ambulatory specialty clinic for a brief behavioral health or social determinants screening when staff document that the patient refused to participate. Typical scenario: a middle-aged adult arrives for a scheduled chronic disease follow-up visit. The medical assistant attempts to complete routine screening for depression, substance use, or a quality metric such as tobacco cessation counseling using standardized tools or structured questionnaires; the patient declines to answer screening questions and explicitly refuses participation. The refusal is documented in the medical record, the clinician notes counseling was offered, and any time spent addressing the refusal (brief explanation and patient education) is recorded. The encounter occurs in ambulatory clinic settings such as primary care, family medicine, internal medicine, psychiatry, or behavioral health integration visits. The service coded with G9728 captures that the patient refused to participate and is used for quality reporting and metric capture rather than payment for a performed clinical procedure.

Coding Specifications

Modifier	Description	When to Use
`23`	Unusual anesthesia	Use if unusual anesthesia circumstances occurred during an attempted procedure; rarely applicable to refusal codes but retained when an anesthetic event preceded a refusal.

HCPCS G8694: Left Ventricular Ejection Fraction ≤40% or Moderate–Severe LVSD

HCPCS-G9808-NO-ASTHMA-CONTROLLER-MEDICATIONS-DISPENSED

HCPCS G9808: No Asthma Controller Medications Dispensed

HCPCS-G2100-FRAILTY-WITH-DEMENTIA-MEDICATION-AGED-66-PLUS

HCPCS G2100: Frailty with Dementia Medication in Patients 66+

HCPCS-G9034-ZANAMIVIR-INHALATION-POWDER-INHALER-10MG

HCPCS G9034: Zanamivir Inhalation Powder, Inhaler, 10 mg

HCPCS-G9869-REMOTE-IMAGE-REVIEW-DERMATOLOGY-OPHTHALMOLOGY

HCPCS G9869: Remote Asynchronous Image Review for Dermatology/Ophthalmology

HCPCS-G8772-DOCUMENTATION-MEDICAL-REASON-OMIT-URINE-PROTEIN-TEST

HCPCS G8772: Documentation of Medical Reason for Omitting Urine Protein Test

HCPCS-G9535-NORMAL-NEUROLOGICAL-EXAMINATION-OUTPATIENT-ASSESSMENT

HCPCS G9535: Normal Neurological Examination

HCPCS-G9107-PANCREATIC-ADENOCARCINOMA-UNRESECTABLE-METASTATIC-DISEASE-STATUS

HCPCS G9107: Pancreatic Adenocarcinoma Disease Status, Advanced

HCPCS-G0090-HOME-INFUSION-INITIAL-VISIT-IV-CHEMOTHERAPY

HCPCS G0090: Initial Home Visit for IV Chemotherapy or Complex Infusion

HCPCS-G0145-CERVICAL-VAGINAL-AUTOMATED-THIN-LAYER-SCREENING

HCPCS G0145: Cervical or Vaginal Screening Cytopathology, Automated Thin-Layer

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly document and manage patient refusals for routine screening and preventive services.
`208D00000X`	Internal Medicine	Internists document refusals during chronic disease management and preventive care workflows.
`2084P0800X`	Psychiatry & Neurology	Behavioral health clinicians encounter refusals to participate in mental health screenings or interventions.
`367500000X`	Nurse Practitioner	NPs frequently perform screening workflows and document patient refusal in ambulatory settings.
`363A00000X`	Physician Assistant	PAs are often involved in preventive screening and document refusal in the medical record.

ICD-10 Code	Description	Clinical Relevance
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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	Often the visit code used for the encounter during which the patient refused participation in a screening or procedure.
`96127`	Brief emotional/behavioral assessment (eg, depression inventory), per standardized instrument	A screening instrument that may have been offered and refused; `G9728` documents the refusal instead of reporting the screening result.
`99406`	Tobacco and/or nicotine cessation counseling, intermediate, greater than 3 minutes up to 10 minutes	Counseling that might be offered and refused; `G9728` documents the refusal for quality reporting.
`G0444`	Annual depression screening, 15 minutes	A preventive screening often offered in primary care; `G9728` indicates the patient declined participation in such screening.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used when a higher-complexity visit occurs and documentation includes a refusal of a targeted screening or service.

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