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See a sample rate comparisonHCPCS G9895 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy)
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Radiology services Prostate |
| Complexity Level | Low |
National average reimbursement for HCPCS G9895 by major payers:
$78.40
$N/A
$0.01
$1.16
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HCPCS G9895
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See a sample payer proposalHCPCS G9895 vs. Other Radiology services Prostate Codes
The HCPCS G9895 code is part of the Procedures / Professional Services services used for Radiology services Prostate. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS G9895 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| G9894-HCPCS | Low | Androgen deprivation therapy prescribed/administered in combination with external beam radiotherapy to the prostate |
| G9895-HCPCS | Low | Documentation of medical reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate (e.g., salvage therapy) |
| G9896-HCPCS | Low | Documentation of patient reason(s) for not prescribing/administering androgen deprivation therapy in combination with external beam radiotherapy to the prostate |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G9895. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G9895 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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