HCPCS Level II · Procedures and professional services (temporary)
G9616Documentation of reason(s) for not documenting a preoperative assessment (e.g., patient with a gynecologic or other pelvic malignancy noted at the time of surgery)
Terminated 12/31/2020
Source: CMS HCPCS quarterly update, October 2026. Page updated September 29, 2026.
About G9616
G9616 is an HCPCS Level II code in the G series (procedures and professional services (temporary)), describing documentation of reason(s) for not documenting a preoperative assessment (e.g., patient with a gynecologic or other pelvic malignancy noted at the time of surgery).
It was added to HCPCS effective 01/01/2016, and its current record took effect 01/01/2021.
It was terminated on 12/31/2020 and can't be billed for later dates of service.
Its Medicare coverage code is "C", meaning coverage is left to the Medicare contractor's judgment.
Details
- Short description
- Doc rsn no preop assmt
- Date added
- 01/01/2016
- Action effective
- 01/01/2021
- Termination date
- 12/31/2020
- BETOS
- Z2
Related G96xx codes
- G9603Patient survey score improved from baseline following treatment
- G9605Patient survey score did not improve from baseline following treatment
- G9606Intraoperative cystoscopy performed to evaluate for lower tract injury
- G9607Documented medical reasons for not performing intraoperative cystoscopy (e.g., urethral pathology precluding cystoscopy, any patient who has a congenital or acquired absence of the urethra) or in the case of patient death
- G9608Intraoperative cystoscopy not performed to evaluate for lower tract injury
- G9609Documentation of an order for anti-platelet agents
- G9610Documentation of medical reason(s) in the patient's record for not ordering anti-platelet agents
- G9611Order for anti-platelet agents was not documented in the patient's record, reason not given
- G9621Patient identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method and received brief counseling
- G9622Patient not identified as an unhealthy alcohol user when screened for unhealthy alcohol use using a systematic screening method
- G9624Patient not screened for unhealthy alcohol use using a systematic screening method or patient did not receive brief counseling if identified as an unhealthy alcohol user
- G9625Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery
Common questions about G9616
Is HCPCS G9616 still valid?
- No. G9616 was terminated on 12/31/2020.
Does Medicare cover G9616?
- Its coverage code is "C": coverage is left to the Medicare contractor's judgment. Check the local coverage determination for your region.