G9904 HCPCS: Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

HCPCS G9904: Documentation of Medical Reason for Not Screening for Tobacco Use

HCPCS Level II code G9904 records documentation of medical reasons for not performing tobacco-use screening (for example, limited life expectancy or other medical reasons). Nationally, this code matters because it captures clinically appropriate exceptions to preventive screening workflows and supports accurate administrative records for quality measurement and claims adjudication. It communicates that the absence of screening was medically justified rather than an omission.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context and expected sites of service, a summary of payer coverage patterns, how G9904 interacts with preventive care documentation and quality reporting, and benchmarks or policy considerations relevant to claims processing and auditing. The review covers how documentation of medical exceptions can affect quality metrics and claims workflows across major national payers.

This publication is intended to inform billing, compliance, and clinical documentation staff about the purpose of G9904, the administrative implications of using the code, and the areas where policy updates or payer-specific guidance may influence its use. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9904HCPCS Level IItobacco screeningpreventive care exceptionclinical documentationquality reportingoutpatient servicesclaims documentation

Billing Code Overview

HCPCS Level II code G9904 documents the medical reason(s) for not screening for tobacco use, such as limited life expectancy or other medical justifications. This code is used when clinicians record why tobacco-use screening was not appropriate for a patient during a visit.

Service Type: Clinical documentation / Preventive care exception

Typical Site of Service: Outpatient clinics, primary care offices, specialty ambulatory settings, and other outpatient encounters where preventive screening would normally occur

Clinical & Coding Specifications

Clinical Context

A typical patient is a frail, elderly individual with advanced metastatic cancer and a limited life expectancy who presents for an outpatient primary care or oncology follow-up visit. During the problem-focused or comprehensive visit the clinician documents that tobacco use screening was considered but not performed because screening and cessation counseling would not alter the plan of care given the patient’s prognosis and goals (for example, focus on comfort measures only). The clinical workflow: the clinician reviews the chart, confirms active tobacco status is not relevant to current goals, documents the medical reason(s) for not screening (e.g., limited life expectancy, severe cognitive impairment, palliative/hospice care) in the encounter note, assigns the appropriate ICD-10 diagnosis(es) reflecting the underlying condition(s), and appends the HCPCS Level II code G9904 on the claim to indicate documentation of medical reasons for not screening for tobacco use. Typical sites of service include physician offices, hospital outpatient clinics, hospice settings, and skilled nursing facilities where clinicians document a clinical justification for omission of tobacco screening.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the documentation supports substantially greater work than typical for the visit where is reported alongside an E/M or other procedure and payor allows modifier on same claim line.

HCPCS G9934: Documentation of Serrated Adenoma or Sessile Serrated Polyp

HCPCS-G8914-ASC-DISCHARGE-HOSPITAL-TRANSFER-OR-ADMISSION

HCPCS G8914: ASC Discharge with Hospital Transfer or Admission

HCPCS-G9638-IMAGING-DOSE-REDUCTION-DOCUMENTATION-DEFICIT

HCPCS G9638: Final Imaging Report Lacking Dose-Reduction Documentation

HCPCS-G9150-NCQA-LEVEL-3-MEDICAL-HOME

HCPCS G9150: NCQA Level 3 Medical Home

HCPCS-G9171-VOICE-FUNCTIONAL-LIMITATION-ASSESSMENT

HCPCS G9171: Voice Functional Limitation Assessment

HCPCS-G9826-TRANSFER-AFTER-INITIATION-CHEMOTHERAPY

HCPCS G9826: Patient Transferred After Initiation of Chemotherapy

HCPCS-G4013-MENTAL-BEHAVIORAL-PSYCHIATRY-MIPS-SPECIALTY-SET

HCPCS G4013: Mental/Behavioral and Psychiatry MIPS Specialty Set

HCPCS-G2123-FRAILTY-WITH-ADVANCED-ILLNESS-66-80-YEARS

HCPCS G2123: Frailty with Advanced Illness, Ages 66–80

HCPCS-G0168-WOUND-CLOSURE-TISSUE-ADHESIVE-ONLY

HCPCS G0168: Wound Closure Using Tissue Adhesive Only

HCPCS-G8400-CENTRAL-DXA-RESULTS-NOT-DOCUMENTED

HCPCS G8400: Central DXA Results Not Documented, Reason Not Given

Showing 1–10 of 1996

G9904

Taxonomy Code	Specialty	Notes
`207RC0000X`	Internal Medicine	Primary care clinicians frequently document reasons for not screening for tobacco use in complex or palliative patients.
`207RN0300X`	Hospice and Palliative Medicine	Specialists often document omission of preventive screenings including tobacco in end-of-life care.
`208000000X`	Family Medicine	Family physicians document screening decisions in outpatient and nursing facility settings.
`208D00000X`	General Practice	General practitioners in clinic and community settings may report `G9904` when screening is not performed for documented medical reasons.
`207L00000X`	Medical Oncology	Oncologists document omission of screening when prognosis or treatment goals render screening irrelevant.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C80.1`	Malignant neoplasm without specification of site, without metastasis	Advanced cancer with limited life expectancy — a common reason to omit tobacco screening.
`Z51.5`	Encounter for palliative care	Explicitly documents palliative goals where preventive screening is often not performed.
`Z51.5`	Encounter for palliative care	(Duplicate entry avoided) — retained once for clarity.
`F03.90`	Unspecified dementia without behavioral disturbance	Severe cognitive impairment can make screening impractical or not meaningful.
`R54`	Age-related physical debility	Frailty or advanced age that limits benefit from screening interventions.
`Z66`	Do not resuscitate status	Indicates goals of care that may justify omission of preventive screening including tobacco use.
`Z51.5`	Encounter for palliative care	(Entry appears multiple times in practice for emphasis) — documents care goals.

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 code billed when a clinician documents medical reasons for not performing tobacco screening during a problem-focused visit; `G9904` can be reported to indicate omission.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used for more complex visits where documentation justifies omission of screening due to medical reasons; pairs with `G9904` on the claim.
`99223`	Initial hospital care, typically 70 minutes	In inpatient or observation settings, clinicians may document reasons for not screening and report `G9904` alongside the initial hospital care code.
`99307`	Subsequent nursing facility care, per day, for the evaluation and management of a patient	In SNF settings where tobacco screening is omitted for clinical reasons, `G9904` supports the claim when billed with nursing facility E/M codes.
`99377`	Physician supervision of hospice care, per 30 minutes	In hospice settings, clinicians supervising care may document omission of tobacco screening and append `G9904` with hospice supervision codes.

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