Question 1

What is HCPCS code G9359?

Accepted Answer

HCPCS code G9359 is "Neg mgd pos tb notact". Documentation of negative or managed positive tb screen with further evidence that tb is not active prior to treatment with a biologic immune response modifier

Question 2

What category is G9359 in?

Accepted Answer

G9359 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9359?

Accepted Answer

Use G9359 when billing for neg mgd pos tb notact. 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 G9359 covered by Medicare?

Accepted Answer

Coverage for G9359 (Neg mgd pos tb notact) 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 G9359?

Accepted Answer

Documentation for G9359 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).