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)

Long description

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)

Short description

Reas no adhere therapy

Pricing indicator

00 Not separately priced by Part B (bundled, not covered or Part A only)

Medicare coverage

C Carrier judgment – coverage decided by the Medicare contractor

BETOS category

M5B Specialist - psychiatry

Added

January 1, 2012

Last change

January 1, 2024 – No change

Nearby G codes

• G8845 – Positive airway pressure therapy prescribed
• G8846 – Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater)
• G8848 – Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15)
• G8849 – Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage)
• G8850 – Positive airway pressure therapy not prescribed, reason not given
• G8851 – Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented)
• G8852 – Positive airway pressure therapy was prescribed
• G8853 – Positive airway pressure therapy not prescribed
• G8855 – Adherence 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
• G8856 – Referral to a physician for an otologic evaluation performed
• G8857 – Patient 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)
• G8858 – Referral to a physician for an otologic evaluation not performed, reason not given
• G8859 – Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
• G8860 – Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
• G8861 – Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribed
• G8862 – Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days