Question 1

What is HCPCS code G2091?

Accepted Answer

HCPCS code G2091 is "Pt 66+ frailty and adv ill". Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period and an advanced illness diagnosis during the measurement period or the year prior to the measurement period

Question 2

What category is G2091 in?

Accepted Answer

G2091 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G2091?

Accepted Answer

Use G2091 when billing for pt 66+ frailty and adv ill. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G2091 covered by Medicare?

Accepted Answer

Coverage for G2091 (Pt 66+ frailty and adv ill) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G2091?

Accepted Answer

Documentation for G2091 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).