G8865 HCPCS Level II Code: Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)
Medicare Coverage & Payment
- CMS short descriptor: Doc med reas no pneumococcal
- 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, 2012
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 G8865 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)
- G8844 — Apnea hypopnea index (ahi), respiratory disturbance index (rdi), or respiratory event index (rei) not documented or measured within 2 months after initial evaluation for suspected obstructive sleep apnea, reason not given[Sibling]— CMS HCPCS Level II code set
- G8845 — Positive airway pressure therapy prescribed[Sibling]— CMS HCPCS Level II code set
- G8846 — Moderate or severe obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of 15 or greater)[Sibling]— CMS HCPCS Level II code set
- G8848 — Mild obstructive sleep apnea (apnea hypopnea index (ahi) or respiratory disturbance index (rdi) of less than 15)[Sibling]— CMS HCPCS Level II code set
- 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)[Sibling]— CMS HCPCS Level II code set
- G8850 — Positive airway pressure therapy not prescribed, reason not given[Sibling]— CMS HCPCS Level II code set
- 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)[Sibling]— CMS HCPCS Level II code set
- G8852 — Positive airway pressure therapy was prescribed[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 medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)
Nearest Codes in This Family
Official HCPCS Level II classifications closest to G8865 in its code family, with their registry titles.
- G8860 — Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
- G8861 — Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for…
- G8862 — Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive days
- G8863 — Patients not assessed for risk of bone loss, reason not given
- G8864 — Pneumococcal vaccine administered or previously received
- G8866 — Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)
- G8867 — Pneumococcal vaccine not administered or previously received, reason not given
- G8868 — Patients receiving a first course of anti-tnf therapy
- G8869 — Patient has documented immunity to hepatitis b and initiating anti-tnf therapy
- G8870 — Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapy