Question 1

What is HCPCS code G8968?

Accepted Answer

HCPCS code G8968 is "Doc med not presb". Documentation 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)

Question 2

What category is G8968 in?

Accepted Answer

G8968 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G8968?

Accepted Answer

Use G8968 when billing for doc med not presb. 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 G8968 covered by Medicare?

Accepted Answer

Coverage for G8968 (Doc med not presb) 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 G8968?

Accepted Answer

Documentation for G8968 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).