Summary & Overview
HCPCS G9736: Patient Refused to Participate
HCPCS Level II code G9736 documents instances when a patient refuses to participate in a recommended service, assessment, or program. Nationally, accurate use of this non-procedure code supports clear administrative records, informs quality measurement, and affects reporting for programs that track patient engagement and consent. Consistent coding helps payers and providers distinguish declines from noncompliance due to access or clinical contraindications.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's purpose, typical service type and sites of service, and discussion of implications for billing workflows and administrative reporting. The publication also summarizes benchmarks and common usage patterns where available, highlights relevant policy considerations affecting documentation and claims adjudication, and provides clinical context on situations that commonly trigger this code.
Data not available in the input is noted where applicable. The content is intended for a national audience of billing professionals, clinical coders, and policy analysts seeking clarity on when and why to report G9736 and what issues to consider when it appears on a claim.
Billing Code Overview
HCPCS Level II code G9736 represents patient refusal to participate. This code denotes situations in which a patient declines to engage in a recommended service, assessment, or program.
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Service type: Patient-declined service
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Typical site of service: Any clinical or care setting where participation is requested, including outpatient clinics, inpatient units, home health encounters, and community-based care
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Clinical & Coding Specifications
Clinical Context
A typical scenario involves an outpatient behavioral health or chronic disease management program scheduling a standardized, structured follow-up or educational session (telephonic or in-person) where the patient declines to participate. Example: a 62-year-old patient with type 2 diabetes and mild depressive disorder is contacted for a scheduled diabetes self-management education session; the patient states they do not wish to participate or refuses consent for the service. The clinical workflow: the care coordinator documents outreach attempts, assesses capacity and reasons for refusal, offers alternatives, and records informed refusal in the medical record. The visit or encounter is closed without delivery of the intended service, and billing uses the refusal code to indicate a completed outreach/attempt where the patient refused participation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when additional work or intensity was provided documenting refusal counseling beyond typical interaction (rare for refusal code). |
23 | Unusual anesthesia | Not typically applicable; include only if anesthesia was attempted but patient refused procedure requiring anesthesia. |