Summary & Overview
HCPCS G9738: Patient Refused to Participate
HCPCS Level II code G9738 records instances where a patient expressly refused to participate in a recommended or offered clinical service. Nationally, refusal codes matter for documenting care decisions, supporting medical necessity narratives, and distinguishing no-treatment events from missed opportunities or administrative denials. Clear documentation using G9738 can affect claims adjudication, quality measurement, and downstream care planning.
Key payers covered in this national overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context and typical sites of service, plus a description of what to expect in payer coverage policy reviews. The publication outlines where G9738 commonly appears on service lines, how it is used in administrative records, and which payers commonly include guidance on refusal documentation.
This summary provides benchmarks and policy update highlights relevant to refusal coding, guidance on documentation elements that payers commonly request, and the clinical context in which refusal is most often recorded. Where input data is missing, the publication notes that information is not available in the input and focuses on broadly applicable national considerations for coding, claims submission, and medical record documentation related to patient refusal.
Billing Code Overview
HCPCS Level II code G9738 denotes Patient refused to participate. This code is used to indicate that a patient declined participation in a service or program when documented by the provider. The service type is a refusal or declination of a recommended or offered clinical service. The typical site of service is any location where the service was offered and declined, including outpatient clinics, physician offices, ambulatory care centers, home health visits, and other ambulatory settings.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an outpatient or facility-based encounter in which a service or program requires active patient participation (for example, a chronic care management call, remote monitoring consent, behavioral health screening, or a post-operative rehabilitation session). During intake or at the point of service the clinician or clinical staff explains the service and documents informed refusal. The patient verbally declines participation or signs a refusal form. The encounter is closed with documentation of the explanation provided, assessment of decision-making capacity if relevant, alternatives offered, and any immediate clinical risk or safety concerns addressed. The site of service is commonly an office, clinic, ambulatory surgery center, or home/telehealth setting when a patient refuses a recommended non-procedural service. The billing action uses G9738 to report that the patient refused to participate, which supports administrative and quality reporting and clarifies why the intended service was not rendered.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work required is substantially greater than usual for the service that was ultimately provided before refusal occurred. |