HCPCS code G9920: Dementia screening billing guide (negative result)

Key Takeaways

HCPCS code G9920 (‘Screening performed and negative’) is a quality-data code for MIPS Quality Measure #283: Dementia-Associated Behavioral and Psychiatric Symptoms Screening and Management.

G9920 is one of three outcome codes for Measure #283: G9919 (positive screen with documented recommendations), G9920 (negative screen), and G9921 (measure not met).

As a quality-data code, G9920 carries $0.00 direct Medicare fee-for-service reimbursement; its value comes from MIPS Quality performance category scoring, not a paid claim line.

California Medi-Cal separately repurposes G9919 and G9920 (never G9921) to bill ACEs screening under its Prop 56 ACEs Aware initiative.

Practice management software like Pabau helps clinicians track quality-data codes like G9920 against qualifying encounters, so a dementia screening doesn’t fall out of a MIPS reporting period.

HCPCS code G9920 documents that a clinician screened a patient with dementia for behavioral and psychiatric symptoms and the result was negative.

This guide covers G9920’s actual clinical purpose under MIPS Measure #283, how it differs from companion codes G9919 and G9921, when to report it, the documentation required, how it connects to Medicare’s quality payment programs, and California’s separate ACEs billing use of G9919/G9920 – clearly scoped so the two don’t get confused.

HCPCS code G9920: Definition and code details

HCPCS code G9920 is an HCPCS Level II G-code with the official descriptor: “Screening performed and negative.” It’s a quality-data code (QDC) used to report the numerator for MIPS Quality Measure #283: Dementia-Associated Behavioral and Psychiatric Symptoms Screening and Management, part of the Merit-based Incentive Payment System (MIPS) under CMS’s Quality Payment Program (QPP).

The code itself is part of the CMS HCPCS Level II code system, maintained annually by the Centers for Medicare and Medicaid Services (CMS).

G9920 isn’t a billable clinical service the way a CPT procedure code is. It’s a status flag: it tells CMS that a clinician screened an eligible dementia patient for behavioral and psychiatric symptoms during a qualifying encounter, and the screen came back negative, satisfying the quality action for that patient in that performance period.

Clinical context: Screening for dementia-associated behavioral and psychiatric symptoms

Behavioral and psychiatric symptoms of dementia (BPSD) – agitation, depression, anxiety, apathy, sleep disturbance, and psychosis such as delusions or hallucinations – affect most people living with dementia at some point in the disease course.

They’re also one of the biggest drivers of caregiver burden and a leading reason people with dementia move into residential care, so identifying and managing them is a genuine clinical priority, not just a reporting exercise.

MIPS Measure #283 operationalizes that priority. It asks whether a clinician documented a screen, using a validated instrument or direct examination of the patient or a knowledgeable informant, across three symptom domains: activity disturbances, mood disturbances (including depression), and thought or perceptual disturbances, at least once in the 12 months following a qualifying encounter.

CMS’s measure specification names the Neuropsychiatric Inventory and, for nursing-home residents, the Minimum Data Set (MDS), while also allowing other reliable and valid instruments that assess the same three domains.

The measure applies to mental and behavioral health practices as well as geriatrics, neurology, and primary care; anywhere a clinician regularly sees patients with a diagnosed dementia.

For practices reporting several MIPS quality measures at once, practice management software like Pabau can help flag which patients are due a screening before their measurement window closes, instead of catching the gap at year-end reporting.

G9919 vs G9920 vs G9921: The three Measure #283 outcomes

Only G9919 and G9920 represent a completed quality action. G9921 exists to flag that the measure wasn’t met – it isn’t an alternate way of documenting “no ACEs” or any other negative finding outside Measure #283, and it plays no role in California’s ACEs billing program covered later in this guide.

When to use HCPCS code G9920

Report G9920 when all of the following are true for the encounter:

• The patient has a diagnosed dementia and was seen during a qualifying encounter (an evaluation and management visit, psychotherapy visit, nursing-facility visit, or another CPT code included in Measure #283’s denominator).
• A behavioral and psychiatric symptoms screen was completed, using a validated instrument or direct examination, covering activity disturbances, mood disturbances (including depression), and thought or perceptual disturbances.
• The screen was negative across all three domains within the 12-month look-back period
• The clinician is reporting Measure #283 as part of traditional MIPS – individually, as a group, or through a qualified registry or QCDR.

Do not report G9920 for a positive screen – use G9919 if management recommendations were documented, or G9921 if they weren’t. Do not report G9920 when no screen was performed at all, or only a partial screen was completed – that’s also G9921.

Do not use G9920 as a general-purpose “negative screening” code outside Measure #283; it has no defined meaning for any other quality measure or clinical scenario, including primary ACEs screening outside California’s Medi-Cal program (see below).

How to bill HCPCS code G9920

MIPS Measure #283 is reported once per performance period for each dementia patient a clinician saw, through whichever collection type the practice uses for the measure – Medicare Part B claims, a qualified registry, or a QCDR.

Using dedicated claims management software to track quality-data codes alongside qualifying E/M and behavioral health claims reduces the risk of a dementia patient falling out of the reporting period unscreened.

1. Confirm the qualifying encounter. The patient needs a documented dementia diagnosis and the encounter must be a qualifying CPT code under Measure #283 (an E/M visit, psychotherapy visit, nursing-facility visit, or similar covered service).
2. Administer the screen. Use a validated instrument, or direct examination of the patient or a knowledgeable informant, covering activity, mood, and thought/perceptual disturbances.
3. Score and document the result. Record which instrument was used and the finding for each of the three domains.
4. Select the outcome code. G9919 for a positive screen with documented recommendations, G9920 for a negative screen, or G9921 if the screen wasn’t completed, was partial, or was positive without documented recommendations.
5. Submit the quality-data code. Report it with the qualifying encounter through your MIPS collection type of choice – claims, registry, or QCDR – within the performance period.

Because G9920 is a quality-data code, it doesn’t generate a separate payment line on the remittance advice. Its value shows up in the MIPS Quality performance category score that feeds into a clinician’s or group’s overall MIPS payment adjustment, so the HIPAA-compliant documentation practices supporting quality reporting matter as much as the code itself.

Manage MIPS quality-data codes without the paperwork headache

Pabau lets you attach quality-data codes like G9920 to qualifying encounters automatically, keep screening documentation audit-ready, and track which patients are due a Measure #283 screening before your reporting period closes – all in one place.

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G9920 reimbursement and the MIPS payment adjustment

G9920 carries $0.00 direct reimbursement under traditional Medicare fee-for-service, consistent with other MIPS quality-data G-codes. Confirm this against the current CMS Physician Fee Schedule lookup tool, since fee schedules are republished annually.

The financial relevance of G9920 isn’t in the code itself – it’s in what accurate, consistent reporting of Measure #283 does to a clinician’s or group’s overall MIPS Quality performance category score, which factors into the MIPS payment adjustment applied to Medicare Part B claims roughly two years later.

Missed or inaccurate screening codes lower the measure’s performance rate and can drag down that composite score.

Whichever collection type a practice uses, the mechanics are the same: G9920 has to be tied to the specific qualifying encounter and dementia patient it documents. A quality-data code submitted without a matching qualifying encounter, or vice versa, won’t count toward the measure.

Documentation requirements for G9920

Billing G9920 without complete supporting documentation is the fastest way to fail an audit of your MIPS quality data. Every element below should appear in the encounter note before the quality-data code is submitted.

• Dementia diagnosis: The qualifying ICD-10-CM dementia code on file for the patient
• Screening method: Which validated instrument was used (for example, the Neuropsychiatric Inventory, or the Minimum Data Set for nursing-home residents), or that a direct examination was performed
• Domains covered: Confirmation that all three required domains were assessed – activity disturbances, mood disturbances (including depression), and thought or perceptual disturbances
• Result: Explicitly recorded as negative across all three domains
• Date and encounter linkage: The screening date, tied to the specific qualifying encounter being reported
• Clinician identification: The clinician who performed or reviewed the screen

Using structured digital intake and assessment forms within your practice management system reduces the risk of missing a documentation field. When the screening instrument is built into a form template, the tool used, the domain-by-domain findings, and the date populate the encounter record automatically, creating an audit trail without extra manual entry.

Maintaining complete patient record systems that link screening results to specific encounters matters just as much for MIPS. Registries and QCDRs can request supporting documentation to validate submitted quality-data codes, and a note that doesn’t clearly tie the screen to the billed encounter is a common reason a quality action gets disallowed on audit.

California Medi-Cal’s separate use of G9919 and G9920 for ACEs screening

Outside of MIPS Measure #283, California’s Medi-Cal program has repurposed two of these same codes – G9919 and G9920 – to bill for a completely different clinical action: screening for Adverse Childhood Experiences (ACEs), potentially traumatic events occurring before age 18 such as abuse, neglect, and household dysfunction.

This is a state-specific program under California’s Proposition 56 directed-payment structure and the Department of Health Care Services’ (DHCS) ACEs Aware initiative. It does not change what G9919 and G9920 mean nationally under MIPS, and G9921 has no role in it whatsoever.

Under ACEs Aware, an enrolled Medi-Cal provider who has completed a certified ACEs Aware core training and attestation can bill G9919 or G9920 for a screening completed with the ACE Questionnaire for Adults or Part 1 of the pediatric PEARLS (Pediatric ACEs and Related Life-events Screener) tool.

Which code applies depends entirely on the patient’s total ACE score, not on the MIPS positive/negative screening framing described above:

• G9919: Total ACE score of 4 or higher (“high risk for toxic stress”)
• G9920: Total ACE score of 0 to 3 (“lower risk for toxic stress”)

Each qualifying screen pays a flat $29, funded by Prop 56 and available only to Medi-Cal providers (including FQHCs, RHCs, and tribal clinics). It isn’t available for patients age 65 and older or for beneficiaries dually eligible for Medi-Cal and Medicare Part B, and it’s generally limited to once per adult lifetime per clinician for patients 21 and older.

Chart documentation should record the tool used, the score, the interpretation, what was discussed with the patient or family, and any follow-up actions taken – kept in the medical record and available on request.

Because the codes look identical on paper, a practice billing both MIPS quality reporting and California ACEs screening for the same patient needs a clear internal rule for which use applies: if the encounter is a Measure #283 dementia screen, code by the behavioral and psychiatric symptoms screening result; if it’s a Medi-Cal ACEs screen under the ACEs Aware program, code by the patient’s ACE score.

The two should never be conflated on the same claim, and the eligibility rules (age limits, training attestation, payment amount) belong to the California program, not to CMS’s quality-measure rules.

Related HCPCS codes: the G9919-G9931 range

G9920 sits inside a numbered run of HCPCS G-codes, but the range isn’t a single unified topic – it spans three unrelated CMS quality measures. Reading it as one “SDoH” or ACEs block is a common mistake. For the full current code set, use the AAPC HCPCS Level II code lookup.

None of these sub-ranges are ACEs-specific. The only ACEs billing use case anywhere in this run is California Medi-Cal’s repurposing of G9919 and G9920, covered above – G9921 and G9922 through G9931 have no role in ACEs billing under any program we could verify.

Confirm the active status of any code in this range against the current CMS HCPCS annual update file before submitting; G-codes can be revised or retired between measurement years.

Common billing errors and how to avoid them

Because G9920 sits at the intersection of a federal quality measure and a California state billing program, most errors come from mixing the two up rather than from the codes themselves.

• Treating G9920 as a general ACEs or SDoH code. Outside California Medi-Cal’s specific ACEs Aware billing use of G9919/G9920, the code’s only defined meaning is the negative-screen outcome for MIPS Measure #283.
• Reporting G9920 for a positive dementia symptoms screen. G9920 is the negative-result code for Measure #283; a positive screen needs G9919 (with documented recommendations) or G9921 (if recommendations weren’t documented).
• Using G9921 as an ACEs “not screened” code. G9921 belongs to Measure #283 only. California’s ACEs Aware program uses G9919 and G9920 exclusively – it does not use G9921 for any purpose.
• Scoring a California ACEs claim using the MIPS positive/negative framing. Medi-Cal’s G9919/G9920 split is based on the patient’s total ACE score (4 or higher vs. 0 to 3), not on whether a behavioral and psychiatric symptoms screen was positive or negative – these are two different scoring logics attached to the same two code numbers.
• Submitting the quality-data code without a qualifying encounter. G9920 has to be tied to a covered CPT encounter under Measure #283, reported through your MIPS collection type’s rules; a quality-data code with no matching qualifying service won’t count.

Tracking which program a given patient encounter belongs to is easier when your billing platform flags the qualifying encounter and the correct code set before submission, rather than relying on a coder to remember two different scoring systems for the same two G-codes.

For a broader look at compliance requirements in your practice documentation, reviewing HIPAA compliance requirements for medical offices can help you build the documentation habits that support quality program audits.

Conclusion

HCPCS code G9920 is a narrow code with two legitimate uses attached to it: reporting a negative dementia behavioral and psychiatric symptoms screen under MIPS Measure #283, and – only in California Medi-Cal, only alongside G9919 – billing an ACEs screening under the state’s Prop 56 ACEs Aware program.

Getting the G9919/G9920/G9921 distinction right for Measure #283, and keeping the California ACEs use case clearly separate from it, protects your quality reporting data and keeps your documentation audit-ready.

Pabau’s claims management software helps practices attach quality-data codes to qualifying encounters, keep screening documentation structured and retrievable, and track MIPS reporting gaps before a performance period closes. If you’re looking to streamline how your practice manages billing codes alongside clinical workflows, book a demo to see how it works in practice.

Continue your research

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