How To Use HCPCS Code G2022

HCPCS code G2022 describes a specific scenario where a model participant, who is an ambulance supplier/provider, offers services to a beneficiary but the beneficiary refuses those services covered under the model. This code is used to indicate situations where the beneficiary declines transportation to an alternate destination or treatment in place.

1. What is HCPCS G2022?

HCPCS code G2022 is a unique alphanumeric code that is used in medical coding and billing to identify a specific scenario where a beneficiary refuses services covered under a model. In this case, the model participant is an ambulance supplier/provider.

2. Official Description

The official description of HCPCS code G2022 is “A model participant (ambulance supplier/provider), the beneficiary refuses services covered under the model (transport to an alternate destination/treatment in place).” The short description for this code is “Benef refuses service, mod.”

3. Procedure

1. The provider initiates the process by offering the services covered under the model to the beneficiary.
2. The beneficiary, for various reasons, refuses the offered services.
3. The provider documents the refusal of services by the beneficiary.
4. The provider may offer alternative options to the beneficiary, such as transportation to an alternate destination or treatment in place.
5. The provider documents any alternative options offered to the beneficiary.

4. When to use HCPCS code G2022

HCPCS code G2022 should be used in situations where a model participant, who is an ambulance supplier/provider, offers services covered under the model to a beneficiary, but the beneficiary refuses those services. This code is specifically used when the refusal involves transportation to an alternate destination or treatment in place.

5. Billing Guidelines and Documentation Requirements

When using HCPCS code G2022, healthcare providers need to document the following:

• The reason for the beneficiary’s refusal of services covered under the model.
• Any alternative options offered to the beneficiary, such as transportation to an alternate destination or treatment in place.
• Any additional relevant information related to the refusal of services.

Providers should ensure that the documentation is accurate, complete, and supports the medical necessity of the services provided.

6. Historical Information and Code Maintenance

HCPCS code G2022 was added to the Healthcare Common Procedure Coding System on January 01, 2020. As of the effective date, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

The coverage and pricing of HCPCS code G2022 may vary depending on the payer, such as Medicare or other insurance providers. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. This means that the service may be bundled with other services or not covered by Medicare.

8. Examples

Here are five examples of scenarios where HCPCS code G2022 should be billed:

1. A model participant, an ambulance supplier, offers transportation services covered under the model to a beneficiary. However, the beneficiary refuses the transportation and opts for treatment in place.
2. A model participant, an ambulance provider, offers transportation services covered under the model to a beneficiary. The beneficiary declines the transportation and chooses to be transported to an alternate destination.
3. A model participant, an ambulance supplier, offers transportation services covered under the model to a beneficiary. The beneficiary refuses the transportation and decides to seek treatment at a different healthcare facility.
4. A model participant, an ambulance provider, offers transportation services covered under the model to a beneficiary. The beneficiary declines the transportation and prefers to arrange their own transportation to the healthcare facility.
5. A model participant, an ambulance supplier, offers transportation services covered under the model to a beneficiary. The beneficiary refuses the transportation and decides to postpone their medical appointment.