G8938 — Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible
G8938 is a HCPCS Level II code for bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible. It belongs to the Procedures and Professional Services (Temporary) section. It was terminated on December 31, 2021 and is not valid on new claims.
This code has been terminated
CMS terminated G8938 on December 31, 2021. It stays in the file as history — a claim you are auditing from before that date may legitimately carry it — but it must not appear on a new claim. The adjacent codes below are the usual place to look for its replacement.
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.
The CMS record for G8938
- Long descriptor
- Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible
- Short descriptor
- Bmi doc onl fup nt doc
- Added
- January 1, 2013
- Terminated
- December 31, 2021
- 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.
When CMS retired it.
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 G8938
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G8938 is not quite right, the correct code is very often within a few positions of it.
- G8930Assessment of depression severity at the initial evaluationterminated
- G8931Assessment of depression severity not documented, reason not giventerminated
- G8932Suicide risk assessed at the initial evaluationterminated
- G8933Suicide risk not assessed at the initial evaluation, reason not giventerminated
- G8934Current or prior left ventricular ejection fraction (lvef) <=40% or documentation of moderately or severely depressed left ventricular systolic function
- G8935Clinician prescribed angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy
- G8936Clinician documented that patient was not an eligible candidate for angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy (eg, allergy, intolerance, pregnancy, renal failure due to ace inhibitor, diseases of the aortic or mitral valve, other medical reasons) or (eg, patient declined, other patient reasons)
- G8937Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given
- G8939Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible at the time of the encounterterminated
- G8940Screening for depression documented as positive, a follow-up plan not completed, documented reasonterminated
- G8941Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible for follow-up plan at the time of the encounterterminated
- G8942Functional outcome assessment using a standardized tool is documented within the previous 30 days and a care plan, based on identified deficiencies is documented within two days of the functional outcome assessment
- G8943Ldl-c result not present or not within 12 months priorterminated
- G8944Ajcc melanoma cancer stage 0 through iic melanoma
- G8946Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasia, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells)
- G8947One or more neuropsychiatric symptomsterminated
Questions about G8938
What is HCPCS code G8938?
G8938 is a HCPCS Level II code for bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligible. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G8938?
The CMS HCPCS file marks G8938 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.
Is G8938 still valid?
No. G8938 was terminated on December 31, 2021 and should not be used on new claims.