G8968 — 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)
G8968 is a HCPCS Level II code for 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). It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusM
Measurement code. Used for reporting purposes only; never paid.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for G8968
- Long descriptor
- 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)
- Short descriptor
- Doc med not presb
- Added
- January 1, 2013
- BETOS
- M5B
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to G8968
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G8968 is not quite right, the correct code is very often within a few positions of it.
- G8960Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition, reason not giventerminated
- G8961Cardiac stress imaging test primarily performed on low-risk surgery patient for preoperative evaluation within 30 days preceding this surgery
- G8962Cardiac stress imaging test performed on patient for any reason including those who did not have low risk surgery or test that was performed more than 30 days preceding low risk surgery
- G8963Cardiac stress imaging performed primarily for monitoring of asymptomatic patient who had pci within 2 yearsterminated
- G8964Cardiac stress imaging test performed primarily for any other reason than monitoring of asymptomatic patient who had pci within 2 years (e.g., symptomatic patient, patient greater than 2 years since pci, initial evaluation, etc)terminated
- G8965Cardiac stress imaging test primarily performed on low chd risk patient for initial detection and risk assessmentterminated
- G8966Cardiac stress imaging test performed on symptomatic or higher than low chd risk patient or for any reason other than initial detection and risk assessmentterminated
- G8967Fda approved oral anticoagulant is prescribed
- G8969Documentation of patient reason(s) for not prescribing an oral anticoagulant that is fda approved for the prevention of thromboembolism (e.g., patient preference for not receiving anticoagulation)
- G8970No risk factors or one moderate risk factor for thromboembolism
- G8971Warfarin or another oral anticoagulant that is fda approved not prescribed, reason not giventerminated
- G8972One or more high risk factors for thromboembolism or more than one moderate risk factor for thromboembolismterminated
- G8973Most recent hemoglobin (hgb) level < 10 g/dlterminated
- G8974Hemoglobin level measurement not documented, reason not giventerminated
- G8975Documentation of medical reason(s) for patient having a hemoglobin level < 10 g/dl (e.g., patients who have non-renal etiologies of anemia [e.g., sickle cell anemia or other hemoglobinopathies, hypersplenism, primary bone marrow disease, anemia related to chemotherapy for diagnosis of malignancy, postoperative bleeding, active bloodstream or peritoneal infection], other medical reasons)terminated
- G8976Most recent hemoglobin (hgb) level >= 10 g/dlterminated
Questions about G8968
What is HCPCS code G8968?
G8968 is a HCPCS Level II code for 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). It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G8968?
The CMS HCPCS file marks G8968 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G8968 paid under the physician fee schedule?
G8968 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.