HCPCS Code S9986: Not Medically Necessary Service (Patient is Aware)

S9986 is not a CPT code but a Level II HCPCS code. It denotes a service that is not medically necessary where the patient is aware and consents to pay for the service out-of-pocket, often used for screening tests like retinal imaging that lack medical necessity.

Procedure code S9986 refers to any not medically necessary service (commonly screening tests) where the patient is informed and financially responsible, such as screening retinal image or OCT done for patient preference rather than medical need.

Yes, they should be, especially that they will be shouldering the cost.