HCPCS code G9919: Screening performed, and positive, and provision of recommendations

Obtain a list of the documentation and billing requirements for HCPCS code G9919 from our short guide.

## **What is HCPCS code G9919?** HCPCS code G9919 is one of the billing codes that denote a screening procedure in which the patient’s result is positive, indicating elevated risk—most commonly applied in Adverse Childhood Experiences (ACEs) screening. When used, the provider must have conducted the screening (e.g., via ACE questionnaire or similar screening tool), determined that the patient’s score met criteria for a positive finding (for example, ACE score 1–3 with clinical concern or ACE score ≥ 4), and delivered appropriate recommendations or interventions in response to that positive result. This procedural code is also utilized in Social Determinants of Health (SDoH) frameworks, where it signals that a screening was performed, at least one need was identified, and recommendations or referrals were provided accordingly.

## **HCPCS code G9919 documentation requirements** Thorough documentation is crucial when using HCPCS code G9919. The medical record must contain all of the following: - **The screening tool used**: The specific, standardized, and clinically validated screening tool must be documented. - **The results of the screen**: Clearly state that the completed screening was positive. - **Interpretation of the results**: Document the provider's assessment of the positive screening and its implications for the patient's health. - **Recommendations provided**: Detail the specific recommendations or actions taken, such as referrals to on-site or community-based resources. - **The discussion with the patient/family**: Note that the results were discussed with the patient or their family, and that they consented to the recommendations or referrals. - **A related diagnosis code**: The claim must include a corresponding ICD-10 Z-code that indicates the specific SDoH need that was identified. For example, Z59.4 for lack of adequate food or Z59.1 for inadequate housing.

## **G9919 billing requirements** Billing for G9919 typically follows these guidelines: - **Claim submission**: G9919 is submitted on a claim form, either a CMS-1500 for professional services or a UB-04 for facility services. - **Relationship to other codes**: G9919 is commonly billed alongside an Evaluation and Management (E/M) code or a preventive medicine service code (e.g., CPT codes like 99203-99205, 99213-99215, or 99381-99396), since the screening is typically documented as part of the overall visit. Payer rules may vary on whether such pairing is required. - **Mutually exclusive**: G9919 is mutually exclusive with G9920, which is the code for a negative screening. You can only bill one of these codes per encounter. - **Reimbursement**: While G9919 is often non-payable, some state Medicaid programs and managed care plans may offer a small incentive payment for reporting this service as part of quality improvement programs. For ACE screening under Medi-Cal, providers must: - Be certified via ACEs Aware Core Training and complete self-attestation. - Bill G9919, when the patient’s ACE score is 4 or greater (high risk). - Receive payment (flat)—for example, $29 per screen—for qualifying screens

## **Other relevant codes** - **G9920**: Screening performed and negative (e.g., ACE score 0–3; SDoH screening with no needs identified). - **G9921**: No screening performed, partial screening performed, or positive screen without recommendations. - **G9922**: Safety concerns screening provided and positive with documented mitigation recommendations. - **G9923**: Safety concerns screening provided and negative.

Frequently asked questions

Yes. Providers must complete the state-mandated ACEs Aware core training and submit a self-attestation before billing Medi-Cal for ACE screenings using G9919.

For Medi-Cal, screenings for children/adolescents (< 21 years) may be repeated annually when medically necessary; for adults (21–64), only one screen per lifetime is reimbursable.

When social needs are identified and referrals made, G9919 must be billed with one or more ICD-10-CM Z-codes (Z55–Z65) that correspond to the identified SDoH domains, as required in some incentive programs like TI 2.0.