Question 1

What is HCPCS code G9264?

Accepted Answer

HCPCS code G9264 is "Doc rsn hemod w/cath >=90d". Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., other medical reasons, patient declined arteriovenous fistula (avf)/arteriovenous graft (avg), other patient reasons)

Question 2

What category is G9264 in?

Accepted Answer

G9264 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9264?

Accepted Answer

Use G9264 when billing for doc rsn hemod w/cath >=90d. 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 G9264 covered by Medicare?

Accepted Answer

Coverage for G9264 (Doc rsn hemod w/cath >=90d) 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 G9264?

Accepted Answer

Documentation for G9264 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).