Question 1

What is HCPCS code G8464?

Accepted Answer

HCPCS code G8464 is "Pt inelig; lo to no dter rsk". Clinician documented that prostate cancer patient is not an eligible candidate for adjuvant hormonal therapy; low or intermediate risk of recurrence or risk of recurrence not determined

Question 2

What category is G8464 in?

Accepted Answer

G8464 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G8464?

Accepted Answer

Use G8464 when billing for pt inelig; lo to no dter rsk. 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 G8464 covered by Medicare?

Accepted Answer

Coverage for G8464 (Pt inelig; lo to no dter rsk) 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 G8464?

Accepted Answer

Documentation for G8464 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).