Question 1

What is HCPCS code G8928?

Accepted Answer

HCPCS code G8928 is "Adj chem not pres rsn spec". Adjuvant chemotherapy not prescribed or previously received, for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons)

Question 2

What category is G8928 in?

Accepted Answer

G8928 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G8928?

Accepted Answer

Use G8928 when billing for adj chem not pres rsn spec. 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 G8928 covered by Medicare?

Accepted Answer

Coverage for G8928 (Adj chem not pres rsn spec) 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 G8928?

Accepted Answer

Documentation for G8928 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).