Question 1

What is HCPCS code G9246?

Accepted Answer

HCPCS code G9246 is "No enc or enc/vir ld 90days". Patient did not have two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart

Question 2

What category is G9246 in?

Accepted Answer

G9246 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9246?

Accepted Answer

Use G9246 when billing for no enc or enc/vir ld 90days. 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 G9246 covered by Medicare?

Accepted Answer

Coverage for G9246 (No enc or enc/vir ld 90days) 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 G9246?

Accepted Answer

Documentation for G9246 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).