G9196 — Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s))
G9196 is a HCPCS Level II code for documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s)). It belongs to the Procedures and Professional Services (Temporary) section. It was terminated on December 31, 2022 and is not valid on new claims.
This code has been terminated
CMS terminated G9196 on December 31, 2022. 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 G9196
- Long descriptor
- Documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s))
- Short descriptor
- Med reason for no ceph
- Added
- January 1, 2014
- Terminated
- December 31, 2022
- 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 G9196
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9196 is not quite right, the correct code is very often within a few positions of it.
- G9188Beta-blocker therapy not prescribed, reason not given
- G9189Beta-blocker therapy prescribed or currently being taken
- G9190Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons)
- G9191Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons)
- G9192Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)terminated
- G9193Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depressionterminated
- G9194Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phaseterminated
- G9195Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phaseterminated
- G9197Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxisterminated
- G9198Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not giventerminated
- G9199Venous thromboembolism (vte) prophylaxis not administered the day of or the day after hospital admission for documented reasons (eg, patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s))terminated
- G9200Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not giventerminated
- G9201Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admissionterminated
- G9202Patients with a positive hepatitis c antibody testterminated
- G9203Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis cterminated
- G9204Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not giventerminated
Questions about G9196
What is HCPCS code G9196?
G9196 is a HCPCS Level II code for documentation of medical reason(s) for not ordering a first or second generation cephalosporin for antimicrobial prophylaxis (e.g., patients enrolled in clinical trials, patients with documented infection prior to surgical procedure of interest, patients who were receiving antibiotics more than 24 hours prior to surgery [except colon surgery patients taking oral prophylactic antibiotics], patients who were receiving antibiotics within 24 hours prior to arrival [except colon surgery patients taking oral prophylactic antibiotics], other medical reason(s)). It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9196?
The CMS HCPCS file marks G9196 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 G9196 still valid?
No. G9196 was terminated on December 31, 2022 and should not be used on new claims.