G8865 — Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)
G8865 is a HCPCS Level II code for documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction). 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 G8865
- Long descriptor
- Documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction)
- Short descriptor
- Doc med reas no pneumococcal
- Added
- January 1, 2012
- BETOS
- M5B
- 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 G8865
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G8865 is not quite right, the correct code is very often within a few positions of it.
- G8857Patient is not eligible for the referral for otologic evaluation measure (e.g., patients who are already under the care of a physician for acute or chronic dizziness)
- G8858Referral to a physician for an otologic evaluation not performed, reason not given
- G8859Patient receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive daysterminated
- G8860Patients who have received dose of corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive daysterminated
- G8861Within the past 2 years, central dual-energy x-ray absorptiometry (dxa) ordered and documented, review of systems and medication history or pharmacologic therapy (other than minerals/vitamins) for osteoporosis prescribedterminated
- G8862Patients not receiving corticosteroids greater than or equal to 10mg/day for 60 or greater consecutive daysterminated
- G8863Patients not assessed for risk of bone loss, reason not given
- G8864Pneumococcal vaccine administered or previously received
- G8866Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)
- G8867Pneumococcal vaccine not administered or previously received, reason not given
- G8868Patients receiving a first course of anti-tnf therapyterminated
- G8869Patient has documented immunity to hepatitis b and initiating anti-tnf therapy
- G8870Hepatitis b vaccine injection administered or previously received and is receiving a first course of anti-tnf therapyterminated
- G8871Patient not receiving a first course of anti-tnf therapyterminated
- G8872Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesionterminated
- G8873Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site)terminated
Questions about G8865
What is HCPCS code G8865?
G8865 is a HCPCS Level II code for documentation of medical reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient allergic reaction, potential adverse drug reaction). It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G8865?
The CMS HCPCS file marks G8865 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 G8865 paid under the physician fee schedule?
G8865 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.