G9938 HCPCS Level II Code: Patients aged 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 six months prior to…
Medicare Coverage & Payment
- CMS short descriptor: Pt 66+ snp or ltc pos > 90d
- Medicare coverage: Carrier judgment (CMS coverage code C)
- Payment category: Service not separately priced (pricing indicator 00)
- BETOS: Z2 — Undefined codes
- 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 G9938 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)
- G9918 — Functional status not performed, reason not otherwise specified[Sibling]— CMS HCPCS Level II code set
- G9919 — Screening performed and positive and provision of recommendations[Sibling]— CMS HCPCS Level II code set
- G9920 — Screening performed and negative[Sibling]— CMS HCPCS Level II code set
- G9921 — No screening performed, partial screening performed or positive screen without recommendations and reason is not given or otherwise specified[Sibling]— CMS HCPCS Level II code set
- G9922 — Safety concerns screen provided and if positive then documented mitigation recommendations[Sibling]— CMS HCPCS Level II code set
- G9923 — Safety concerns screen provided and negative[Sibling]— CMS HCPCS Level II code set
- G9924 — Documentation of medical reason(s) for not providing safety concerns screen or for not providing recommendations, orders or referrals for positive screen (e.g., patient in palliative care, other medical reason)[Sibling]— CMS HCPCS Level II code set
- G9925 — Safety concerns screening not provided, reason not otherwise specified[Sibling]— CMS HCPCS Level II code set
- and 32 more
Change history
- January 1, 2018 — 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, 2018Added to the code setPatients aged 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 six months prior to the measurement period through december 31 of the measurement period
Nearest Codes in This Family
Official HCPCS Level II classifications closest to G9938 in its code family, with their registry titles.
- G9933 — Adenoma(s) or colorectal cancer detected during screening colonoscopy
- G9934 — Documentation that neoplasm detected is only diagnosed as traditional serrated adenoma, sessile serrated polyp, or sessile serrated adenoma
- G9935 — Adenoma(s) or colorectal cancer not detected during screening colonoscopy
- G9936 — Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus
- G9937 — Diagnostic colonoscopy
- G9939 — Pathologists/dermatopathologists is the same clinician who performed the biopsy
- G9940 — Documentation of medical reason(s) for not on a statin (e.g., pregnancy, in vitro fertilization, clomiphene rx, esrd, cirrhosis, muscular pain and disease during the measurement period or prior year)
- G9941 — Back pain was measured by the visual analog scale (vas) within three months preoperatively and at three months (6 - 20 weeks) postoperatively
- G9942 — Patient had any additional spine procedures performed on the same date as the lumbar discectomy/laminectomy
- G9943 — Back pain was not measured by the visual analog scale (vas) or numeric pain scale at three months (6 - 20 weeks) postoperatively