Question 1

What is HCPCS code G9836?

Accepted Answer

HCPCS code G9836 is "Rsn no trast given doc". Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete)

Question 2

What category is G9836 in?

Accepted Answer

G9836 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9836?

Accepted Answer

Use G9836 when billing for rsn no trast given doc. 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 G9836 covered by Medicare?

Accepted Answer

Coverage for G9836 (Rsn no trast given doc) 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 G9836?

Accepted Answer

Documentation for G9836 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).