Question 1

What is HCPCS code G9765?

Accepted Answer

HCPCS code G9765 is "Doc pat declined therapy". Documentation that the patient declined change in medication or alternative therapies were unavailable, has documented contraindications, or has not been treated with a systemic medication for at least six consecutive months (e.g., experienced adverse effects or lack of efficacy with all other therapy options) in order to achieve better disease control as measured by pga, bsa, pasi, or dlqi

Question 2

What category is G9765 in?

Accepted Answer

G9765 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9765?

Accepted Answer

Use G9765 when billing for doc pat declined 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 G9765 covered by Medicare?

Accepted Answer

Coverage for G9765 (Doc pat declined 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 G9765?

Accepted Answer

Documentation for G9765 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).