G8854 HCPCS Level II Code: 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…
Medicare Coverage & Payment
- CMS short descriptor: Reas no adhere therapy
- Medicare coverage: Carrier judgment (CMS coverage code C)
- Payment category: Service not separately priced (pricing indicator 00)
- BETOS: M5B — Specialist - psychiatry
- Last CMS action effective: January 1, 2024
Source: CMS HCPCS Level II release. Coverage codes indicate how Medicare treats the code, not whether a specific claim will be paid; payer policy and documentation still govern.
Contextual Map
Every relationship of G8854 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.
Nearest codes (40)
- G8818 — Patient discharge to home no later than post-operative day #7[Sibling]— CMS HCPCS Level II code set
- G8825 — Patient not discharged to home by post-operative day #7[Sibling]— CMS HCPCS Level II code set
- G8826 — Patient discharged to home no later than post-operative day #2 following evar[Sibling]— CMS HCPCS Level II code set
- G8833 — Patient not discharged to home by post-operative day #2 following evar[Sibling]— CMS HCPCS Level II code set
- G8834 — Patient discharged to home no later than post-operative day #2 following cea[Sibling]— CMS HCPCS Level II code set
- G8838 — Patient not discharged to home by post-operative day #2 following cea[Sibling]— CMS HCPCS Level II code set
- G8839 — Sleep apnea symptoms assessed, including presence or absence of snoring and daytime sleepiness[Sibling]— CMS HCPCS Level II code set
- G8840 — Documentation 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)[Sibling]— CMS HCPCS Level II code set
- and 32 more
Change history
- January 1, 2012 — Added to the code set [Change history]— CMS release files (code change ledger)
Sources for this page
Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.
- Code, descriptors, coverage and pricing attributes Official source data
- CMS HCPCS Alpha-Numeric (ANWEB) release — July 2026 quarterly update Release, file and checksum · Publisher’s page
- Change history and date-of-service validity Official source data
- CMS HCPCS quarterly update files, ingested into the change ledger Release, file and checksum · Publisher’s page
- Comparisons, relationships and the contextual map MedCoder structured relationship
- Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
- Summary and FAQ answers MedCoder explanation
- Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.
Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates
Change history
- January 1, 2012Added to the code setDocumentation 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)
Nearest Codes in This Family
Official HCPCS Level II classifications closest to G8854 in its code family, with their registry titles.
- G8849 — Documentation of reason(s) for not prescribing positive airway pressure therapy (e.g., patient unable to tolerate, alternative therapies use, patient declined, financial, insurance coverage)
- G8850 — Positive airway pressure therapy not prescribed, reason not given
- G8851 — Adherence to therapy was assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available, documented)
- G8852 — Positive airway pressure therapy was prescribed
- G8853 — Positive airway pressure therapy not prescribed
- G8855 — Adherence to therapy was not assessed at least annually through an objective informatics system or through self-reporting (if objective reporting is not available), reason not given
- G8856 — Referral to a physician for an otologic evaluation performed
- G8857 — Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)
- G8858 — Referral to a physician for an otologic evaluation not performed, reason not given
- G8859 — Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days