G8946 — Minimally 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)
G8946 is a HCPCS Level II code for minimally 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). 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
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for G8946
- Long descriptor
- Minimally 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)
- Short descriptor
- Mibm but no dx of breast ca
- Added
- January 1, 2013
- 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 G8946
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G8946 is not quite right, the correct code is very often within a few positions of it.
- G8937Clinician did not prescribe angiotensin converting enzyme (ace) inhibitor or angiotensin receptor blocker (arb) therapy, reason not given
- G8938Bmi is documented as being outside of normal parameters, follow-up plan is not documented, documentation the patient is not eligibleterminated
- 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
- G8947One or more neuropsychiatric symptomsterminated
- G8948No neuropsychiatric symptomsterminated
- G8949Documentation of patient reason(s) for patient not receiving counseling for diet and physical activity (e.g., patient is not willing to discuss diet or exercise interventions to help control blood pressure, or the patient said he/she refused to make these changes)terminated
- G8950Elevated or hypertensive blood pressure reading documented, and the indicated follow-up is documented
- G8951Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligibleterminated
- G8952Elevated or hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
- G8953All quality actions for the applicable measures in the oncology measures group have been performed for this patientterminated
- G8955Most recent assessment of adequacy of volume management documented
Questions about G8946
What is HCPCS code G8946?
G8946 is a HCPCS Level II code for minimally 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). It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G8946?
The CMS HCPCS file marks G8946 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 G8946 paid under the physician fee schedule?
G8946 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.