Question 1

What is HCPCS code G8854?

Accepted Answer

HCPCS code G8854 is "Reas no adhere therapy". 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)

Question 2

What category is G8854 in?

Accepted Answer

G8854 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G8854?

Accepted Answer

Use G8854 when billing for reas no adhere therapy. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G8854 covered by Medicare?

Accepted Answer

Coverage for G8854 (Reas no adhere therapy) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G8854?

Accepted Answer

Documentation for G8854 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).