G8540 — Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter
G8540 is a HCPCS Level II code for functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusM
Measurement code. Used for reporting purposes only; never paid.
Global period: XXX
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The CMS record for G8540
- Long descriptor
- Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter
- Short descriptor
- Foa not doc as being perf
- Added
- January 1, 2009
- BETOS
- M5D
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to G8540
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G8540 is not quite right, the correct code is very often within a few positions of it.
- G8510Screening for depression is documented as negative, a follow-up plan is not required
- G8511Screening for depression documented as positive, follow-up plan not documented, reason not given
- G8530Autogenous av fistula receivedterminated
- G8531Clinician documented that patient was not an eligible candidate for autogenous av fistulaterminated
- G8532Clinician documented that patient received vascular access other than autogenous av fistula, reason not giventerminated
- G8535Elder maltreatment screen not documented; documentation that patient is not eligible for the elder maltreatment screen at the time of the encounter related to one of the following reasons: (1) patient refuses to participate in the screening and has reasonable decisional capacity for self-protection, or (2) patient is in an urgent or emergent situation where time is of the essence and to delay treatment to perform the screening would jeopardize the patient's health status
- G8536No documentation of an elder maltreatment screen, reason not given
- G8539Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies is documented within two days of the functional outcome assessment
- G8541Functional outcome assessment using a standardized tool not documented, reason not given
- G8542Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required
- G8543Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented within two days of assessment, reason not given
- G8544I intend to report the coronary artery bypass graft (cabg) measures groupterminated
- G8545I intend to report the hepatitis c measures groupterminated
- G8547I intend to report the ischemic vascular disease (ivd) measures groupterminated
- G8548I intend to report the heart failure (hf) measures groupterminated
- G8549All quality actions for the applicable measures in the hepatitis c measures group have been performed for this patientterminated
Questions about G8540
What is HCPCS code G8540?
G8540 is a HCPCS Level II code for functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool at the time of the encounter. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G8540?
The CMS HCPCS file marks G8540 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G8540 paid under the physician fee schedule?
G8540 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.