HCPCS Level II · Procedures and professional services (temporary)
G8854Documentation 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)
Source: CMS HCPCS quarterly update, October 2026. Page updated September 29, 2026.
About G8854
G8854 is an HCPCS Level II code in the G series (procedures and professional services (temporary)), describing 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).
It was added to HCPCS effective 01/01/2012, and its current record took effect 01/01/2024.
Its Medicare coverage code is "C", meaning coverage is left to the Medicare contractor's judgment.
Details
- Short description
- Reas no adhere therapy
- Date added
- 01/01/2012
- Action effective
- 01/01/2024
- BETOS
- M5B
Related G88xx codes
- G8806Performance of trans-abdominal or trans-vaginal ultrasound and pregnancy location documented
- G8807Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has a documented intrauterine pregnancy [iup])
- G8808Trans-abdominal or trans-vaginal ultrasound not performed, reason not given
- G8815Documented reason in the medical records for why the statin therapy was not prescribed (i.e., lower extremity bypass was for a patient with non-artherosclerotic disease)
- G8816Statin medication prescribed at discharge
- G8817Statin therapy not prescribed at discharge, reason not given
- G8826Patient discharged to home no later than post-operative day #2 following evar
- G8833Patient not discharged to home by post-operative day #2 following evar
- G8834Patient discharged to home no later than post-operative day #2 following cea
- G8838Patient not discharged to home by post-operative day #2 following cea
- G8839Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness
- G8840Documentation of reason(s) for not documenting an assessment of sleep symptoms (e.g., patient didn't have initial daytime sleepiness, patient visited between initial testing and initiation of therapy)
Common questions about G8854
Is HCPCS G8854 still valid?
- Yes. G8854 is active in the CMS October 2026 HCPCS file.
Does Medicare cover G8854?
- Its coverage code is "C": coverage is left to the Medicare contractor's judgment. Check the local coverage determination for your region.