Question 1

What is HCPCS code G9220?

Accepted Answer

HCPCS code G9220 is "No order for pjp for medrsn". Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)

Question 2

What category is G9220 in?

Accepted Answer

G9220 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9220?

Accepted Answer

Use G9220 when billing for no order for pjp for medrsn. 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 G9220 covered by Medicare?

Accepted Answer

Coverage for G9220 (No order for pjp for medrsn) 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 G9220?

Accepted Answer

Documentation for G9220 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).