G9896 — Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate
G9896 is a HCPCS Level II code for documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate. 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 G9896
- Long descriptor
- Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate
- Short descriptor
- Doc pt rsn no adr dep thrpy
- Added
- January 1, 2018
- BETOS
- Z2
- 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 G9896
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9896 is not quite right, the correct code is very often within a few positions of it.
- G9887Behavioral counseling for diabetes prevention, distance learning, 60 minutes
- G9888Maintenance 5% wl from baseline weight in months 7-12
- G9890Bridge payment: a one-time payment for the first medicare diabetes prevention program (mdpp) core session, core maintenance session, or ongoing maintenance session furnished by an mdpp supplier to an mdpp beneficiary during months 1-24 of the mdpp expanded model (em) who has previously received mdpp services from a different mdpp supplier under the mdpp expanded model. a supplier may only receive one bridge payment per mdpp beneficiary
- G9891Mdpp session reported as a line-item on a claim for a payable mdpp expanded model (em) hcpcs code for a session furnished by the billing supplier under the mdpp expanded model and counting toward achievement of the attendance performance goal for the payable mdpp expanded model hcpcs code (this code is for reporting purposes only)
- G9892Documentation of patient reason(s) for not performing a dilated macular examinationterminated
- G9893Dilated macular exam was not performed, reason not otherwise specifiedterminated
- G9894Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate
- G9895Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy)
- G9897Patients who were not prescribed/administered androgen deprivation therapy in combination with external beam radiotherapy to the prostate, reason not given
- G9898Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
- G9899Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results documented and reviewed
- G9900Screening, diagnostic, film, digital or digital breast tomosynthesis (3d) mammography results were not documented and reviewed, reason not otherwise specified
- G9901Patient age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the measurement period
- G9902Patient screened for tobacco use and identified as a tobacco user
- G9903Patient screened for tobacco use and identified as a tobacco non-user
- G9904Documentation of medical reason(s) for not screening for tobacco use (e.g., limited life expectancy, other medical reason)terminated
Questions about G9896
What is HCPCS code G9896?
G9896 is a HCPCS Level II code for documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9896?
The CMS HCPCS file marks G9896 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 G9896 paid under the physician fee schedule?
G9896 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.