Question 1

What is HCPCS code G8628?

Accepted Answer

HCPCS code G8628 is "No surg proc w/in 30 days". Surgical procedure not performed within 30 days following cataract surgery for major complications (e.g., retained nuclear fragments, endophthalmitis, dislocated or wrong power iol, retinal detachment, or wound dehiscence)

Question 2

What category is G8628 in?

Accepted Answer

G8628 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G8628?

Accepted Answer

Use G8628 when billing for no surg proc w/in 30 days. 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 G8628 covered by Medicare?

Accepted Answer

Coverage for G8628 (No surg proc w/in 30 days) 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 G8628?

Accepted Answer

Documentation for G8628 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).