HCPCS code G9920: Screening performed and negative

Learn more about how to properly use and code for HCPCS code G9920 from our short guide.

## **What is HCPCS code G9920?** HCPCS code G9920, which has the technical term "screening performed and negative," denotes a screening performed that yields a negative result. Also known as the medical HCPCS procedure "screening performed and negative," the code is used when a provider conducts a screening process and the results are negative, indicating no issues or risk detected. Initially applied in contexts like Adverse Childhood Experiences (ACEs) or Social Determinants of Health (SDOH), it captures screening activities where no risk or need is identified, yet results have been reviewed and discussed, and appropriate education or intervention is still provided. In this context, G9920 is billed when the screening is performed and the result indicates a lower risk for toxic stress (e.g., an ACE score of 0 to 3).

## **HCPCS code G9920 documentation requirements** Documentation must be sufficient to support that the screening was performed and to justify the result. For screenings like the ACEs assessment, state programs (such as California's Medi-Cal) require the following documentation: - **Screening tool, equipment, and technology used**: Documentation of the specific, validated screening tool administered to the patient. - **Review and interpretation**: A note confirming that the completed screen was reviewed and that the provider interpreted the results. - **Results of the screen**: The actual score or finding from the screening (e.g., the ACE score) was negative (no risk identified) - **Discussion and actions**: Documentation of what was discussed with the patient and/or family based on the negative/low-risk result, and any appropriate follow-up actions taken (e.g., education, routine follow-up, early intervention, and treatment). For all Medicare services, general documentation rules apply: the medical record must support that the service was performed, is medically necessary (if applicable to the code), and all billing requirements are met. Do note that, depending on the payer or regional program, attestation or provider certification may be required.

## **G9920 billing requirements** To properly bill for HCPCS code G9920, one must consider the following requirements: - **Payer specificity**: The payment for G9920 is highly payer-specific. Although it is a standardized national code, Medicare generally lists it as non-payable and not separately priced. - **Medicaid/state programs (e.g., Medi-Cal**): State Medicaid programs often use G9920 as a mechanism for payment for non-covered but important preventative screenings, such as the ACEs screening, often with a fixed reimbursement rate (e.g., $29 in California as of previous updates). - **Non-covered vs. incentive payment**: For some payers, G9920 is considered a "non-covered" or "non-payable" code that is used exclusively for quality measure tracking or to trigger an incentive payment (a small reimbursement paid to the provider for performing the screening, separate from the primary E/M service). - **Non-billable for refusal**: The code should not be submitted if a patient or family member declines the screening. It is only used when the screening is successfully completed. - **Claim form**: Typically billed on the CMS-1500 claim form for professional services.

## **Other relevant codes** - **G9919**: Screening performed and positive, and provision of recommendations. - **G9923**: Safety concerns screen provided and negative - **G9922**: Safety concerns screen provided, and if positive, then documented mitigation recommendations.

Frequently asked questions

Yes. The performed and negative (G9920) should be used when the screening is completed and yields a negative result. It captures the screening activity and subsequent patient education, even though no risk was identified.

No. Medicare designates G9920 as not payable. Coverage payments for ACE or SDOH screenings are often limited to state Medicaid programs or specific incentives.

G9920 is for a negative (low-risk) screening result, while G9919 is for a positive (high-risk) screening result that also includes the provision of recommendations or interventions.