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G8854 Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy)
BackG8395Left ventricular ejection fraction (lvef) >= 40% or documentation as normal or mildly depressed left ventricular systolic function→G8396Left ventricular ejection fraction (lvef) not performed or documented→G8397Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy→G8399Patient with documented results of a central dual-energy x-ray absorptiometry (dxa) ever being performed→G8400Patient with central dual-energy x-ray absorptiometry (dxa) results not documented, reason not given→G8404Lower extremity neurological exam performed and documented→G8405Lower extremity neurological exam not performed→G8410Footwear evaluation performed and documented→G8415Footwear evaluation was not performed→G8416Clinician documented that patient was not an eligible candidate for footwear evaluation measure→G8417Bmi is documented above normal parameters and a follow-up plan is documented→G8418Bmi is documented below normal parameters and a follow-up plan is documented→G8419Bmi documented outside normal parameters, no follow-up plan documented, no reason given→G8420Bmi is documented within normal parameters and no follow-up plan is required→G8421Bmi not documented and no reason is given→G8427Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications→G8428Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given→G8430Documentation of a medical reason(s) for not documenting, updating, or reviewing the patient's current medications list (e.g., patient is in an acute health crisis where time is of the essence and delay of treatment would jeopardize the patient's health status)→G8431Screening for depression is documented as being positive and a follow-up plan is documented→G8432Depression screening not documented, reason not given→G8433Screening for depression not completed, documented patient or medical reason→G8450Beta-blocker therapy prescribed→G8451Beta-blocker therapy for lvef <=40% not prescribed for reasons documented by the clinician (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons, patient declined, other patient reasons)→G8452Beta-blocker therapy not prescribed→G8465High or very high risk of recurrence of prostate cancer→G8473Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy prescribed→G8474Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed for reasons documented by the clinician (e.g., allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (e.g., patient declined, other patient reasons)→G8475Angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy not prescribed, reason not given→G8476Most recent blood pressure has a systolic measurement of < 140 mmhg and a diastolic measurement of < 90 mmhg→G8477Most recent blood pressure has a systolic measurement of >= 140 mmhg and/or a diastolic measurement of >= 90 mmhg→G8478Blood pressure measurement not performed or documented, reason not given→G8510Screening for depression is documented as negative, a follow-up plan is not required→G8511Screening for depression documented as positive, follow-up plan not documented, reason not given→G8535Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter related to one of the following reasons: (1) patient refuses to participate in the screening and has reasonable decisional capacity for self-protection, or (2) patient is in an urgent or emergent situation where time is of the essence and to delay treatment to perform the screening would jeopardize the patient's health status→G8536No documentation of an elder maltreatment screen, reason not given→G8539Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies is documented within two days of the functional outcome assessment→G8540Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter→G8541Functional outcome assessment using a standardized tool not documented, reason not given→G8542Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required→G8543Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given→G8559Patient referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation→G8560Patient has a history of active drainage from the ear within the previous 90 days→G8561Patient is not eligible for the referral for otologic evaluation for patients with a history of active drainage measure→G8562Patient does not have a history of active drainage from the ear within the previous 90 days→G8563Patient not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given→G8564Patient was referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not specified)→G8565Verification and documentation of sudden or rapidly progressive hearing loss→G8566Patient is not eligible for the "referral for otologic evaluation for sudden or rapidly progressive hearing loss" measure→G8567Patient does not have verification and documentation of sudden or rapidly progressive hearing loss→G8568Patient was not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given→G8569Prolonged postoperative intubation (> 24 hrs) required→G8570Prolonged postoperative intubation (> 24 hrs) not required→G8575Developed postoperative renal failure or required dialysis→G8576No postoperative renal failure/dialysis not required→G8577Re-exploration required due to mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native, vessel, graft, or both), valve dysfunction, aortic reintervention, or other cardiac reason→G8578Re-exploration not required due to mediastinal bleeding with or without tamponade, unplanned coronary artery intervention (native, vessel, graft, or both), valve dysfunction, aortic reintervention, or other cardiac reason→G8598Aspirin or another antiplatelet therapy used→G8599Aspirin or another antiplatelet therapy not used, reason not given→G8600Iv thrombolytic therapy initiated within 4.5 hours (<= 270 minutes) of time last known well→G8601Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well for reasons documented by clinician (e.g. patient enrolled in clinical trial for stroke, patient admitted for elective carotid intervention)→G8602Iv thrombolytic therapy not initiated within 4.5 hours (<= 270 minutes) of time last known well, reason not given→G8633Pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed→G8635Pharmacologic therapy for osteoporosis was not prescribed, reason not given→G8647Residual score for the knee impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)→G8648Residual score for the knee impairment successfully calculated and the score was less than zero (< 0)→G8650Residual score for the knee impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given→G8651Residual score for the hip impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)→G8652Residual score for the hip impairment successfully calculated and the score was less than zero (< 0)→G8654Residual score for the hip impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given→G8655Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was equal to zero (0) or greater than zero ( > 0)→G8656Residual score for the lower leg, foot or ankle impairment successfully calculated and the score was less than zero (< 0)→G8658Residual score for the lower leg, foot or ankle impairment not measured because the patient did not complete the lepf prom at initial evaluation and/or near discharge, reason not given→G8659Residual score for the low back impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)→G8660Residual score for the low back impairment successfully calculated and the score was less than zero (< 0)→G8661Risk-adjusted functional status change residual score for the low back impairment not measured because the patient did not complete the fs status survey near discharge, patient not appropriate→G8662Residual score for the low back impairment not measured because the patient did not complete the low back fs prom at initial evaluation and/or near discharge, reason not given→G8663Residual score for the shoulder impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)→G8664Residual score for the shoulder impairment successfully calculated and the score was less than zero (< 0)→G8666Residual score for the shoulder impairment not measured because the patient did not complete the shoulder fs prom at initial evaluation and/or near discharge, reason not given→G8667Residual score for the elbow, wrist or hand impairment successfully calculated and the score was equal to zero (0) or greater than zero (> 0)→G8668Residual score for the elbow, wrist or hand impairment successfully calculated and the score was less than zero (< 0)→G8670Residual score for the elbow, wrist or hand impairment not measured because the patient did not complete the elbow/wrist/hand fs prom at initial evaluation and/or near discharge, reason not given→G8694Current or prior left ventricular ejection fraction (lvef) < = 40% or documentation of moderate or severe lvsd→G8708Patient not prescribed antibiotic→G8709Uri episodes when the patient had competing diagnoses on or three days after the episode date (e.g., intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis or uti, and acne)→G8710Patient prescribed antibiotic→G8711Prescribed antibiotic on or within 3 days after the episode date→G8712Antibiotic not prescribed or dispensed→G8721Pt category (primary tumor), pn category (regional lymph nodes), and histologic grade were documented in pathology report→G8722Documentation of medical reason(s) for not including the pt category, the pn category or the histologic grade in the pathology report (e.g., re-excision without residual tumor; non-carcinomasanal canal)→G8723Specimen site is other than anatomic location of primary tumor→G8724Pt category, pn category and histologic grade were not documented in the pathology report, reason not given→G8733Elder maltreatment screen documented as positive and a follow-up plan is documented→G8734Elder maltreatment screen documented as negative, follow-up is not required→G8735Elder maltreatment screen documented as positive, follow-up plan not documented, reason not given→G8749Absence of signs of melanoma (tenderness, jaundice, localized neurologic signs such as weakness, or any other sign suggesting systemic spread) or absence of symptoms of melanoma (cough, dyspnea, pain, paresthesia, or any other symptom suggesting the possibility of systemic spread of melanoma)→G8752Most recent systolic blood pressure < 140 mmhg→G8753Most recent systolic blood pressure >= 140 mmhg→G8754Most recent diastolic blood pressure < 90 mmhg→G8755Most recent diastolic blood pressure >= 90 mmhg→G8756No documentation of blood pressure measurement, reason not given→G8783Normal blood pressure reading documented, follow-up not required→G8785Blood pressure reading not documented, reason not given→G8797Specimen site other than anatomic location of esophagus→G8798Specimen site other than anatomic location of prostate→G8806Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented→G8807Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup])→G8808Trans-abdominal or trans-vaginal ultrasound not performed, reason not given→G8815Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease)→G8816Statin medication prescribed at discharge→G8817Statin therapy not prescribed at discharge, reason not given→G8826Patient discharged to home no later than post-operative day #2 following evar→G8833Patient not discharged to home by post-operative day #2 following evar→G8834Patient discharged to home no later than post-operative day #2 following cea→G8838Patient not discharged to home by post-operative day #2 following cea→G8839Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness→G8840Documentation of reason(s) for not documenting an assessment of sleep symptoms (e.g., patient didn't have initial daytime sleepiness, patient visited between initial testing and initiation of therapy)→G8841Sleep apnea symptoms not assessed, reason not given→G8842Apnea hypopnea index (ahi), respiratory disturbance index (rdi) or respiratory event index (rei) documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea→G8843Documentation of reason(s) for not measuring an apnea hypopnea index (ahi), a respiratory disturbance index (rdi), or a respiratory event index (rei) within 2 months after initial evaluation for suspected obstructive sleep apnea (e.g., medical, neurological, or psychiatric disease that prohibits successful completion of a sleep study, patients for whom a sleep study would present a bigger risk than benefit or would pose an undue burden, dementia, patients previously diagnosed with osa and severity assessed by another provider, patients who decline ahi/rdi/rei measurement, patients who had a financial reason for not completing testing, test was ordered but not completed, patients decline because their insurance (payer) does not cover the expense)→G8844Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea, reason not given→G8845Positive airway pressure therapy prescribed→G8846Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater)→G8849Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage)→G8850Positive airway pressure therapy not prescribed, reason not given→G8851Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented)→G8854Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy)→G8855Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given→G8856Referral to a physician for an otologic evaluation performed→G8857Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)→G8858Referral to a physician for an otologic evaluation not performed, reason not given→G8863Patients not assessed for risk of bone loss, reason not given→G8864Pneumococcal vaccine administered or previously received→G8865Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)→G8866Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)→G8867Pneumococcal vaccine not administered or previously received, reason not given→G8869Patient has documented immunity to hepatitis b and initiating anti-tnf therapy→G8875Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method→G8876Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician)→G8877Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given→G8878Sentinel lymph node biopsy procedure performed→G8880Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)→G8881Stage of breast cancer is greater than t1n0m0 or t2n0m0→G8882Sentinel lymph node biopsy procedure not performed, reason not given→G8907Patient documented not to have experienced any of the following events: a burn prior to discharge; a fall within the facility; wrong site/side/patient/procedure/implant event; or a hospital transfer or hospital admission upon discharge from the facility→G8908Patient documented to have received a burn prior to discharge→G8909Patient documented not to have received a burn prior to discharge→G8910Patient documented to have experienced a fall within asc→G8911Patient documented not to have experienced a fall within ambulatory surgical center→G8912Patient documented to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event→G8913Patient documented not to have experienced a wrong site, wrong side, wrong patient, wrong procedure or wrong implant event→G8914Patient documented to have experienced a hospital transfer or hospital admission upon discharge from asc→G8915Patient documented not to have experienced a hospital transfer or hospital admission upon discharge from asc→G8916Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic initiated on time→G8917Patient with preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis, antibiotic not initiated on time→G8918Patient without preoperative order for iv antibiotic surgical site infection (ssi) prophylaxis→G8923Current or prior left ventricular ejection fraction (lvef) <= 40% or documentation of moderately or severely depressed left ventricular systolic function→G8924Spirometry results documented (fev1/fvc < 70%)→G8934Current or prior left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function→G8935Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy→G8936Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons)→G8937Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given→G8942Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies is documented within two days of the functional outcome assessment→G8944Ajcc melanoma cancer stage 0 through iic melanoma→G8946Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells)→G8950Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented→G8952Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given→G8955Most recent assessment of adequacy of volume management documented→G8956Patient receiving maintenance hemodialysis in an outpatient dialysis facility→G8958Assessment of adequacy of volume management not documented, reason not given→G8961Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery→G8962Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery→G8967Fda approved oral anticoagulant is prescribed→G8968Documentation of medical reason(s) for not prescribing an fda-approved anticoagulant (e.g., present or planned atrial appendage occlusion or ligation or patient being currently enrolled in a clinical trial related to af/atrial flutter treatment)→G8969Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation)→G8970No risk factors or one moderate risk factor for thromboembolism→
Procedure codeCODABLE
G8854
Documentation of reason(s) for not objectively reporting adherence to evidence-based therapy (e.g., patients who have been diagnosed with a terminal or advanced disease with an expected life span of less than 6 months, patients who decline therapy, patients who do not return for follow-up at least annually, patients unable to access/afford therapy, patient's insurance will not cover therapy)
- Part
- HCPCS Level II
- G
- Procedures and Professional Services (Temporary)
- G8
- G8395–G8970
Source
CMS — ICD-10-PCS FY2026, HCPCS Level II october 2026, Procedure Codes 2026.