Question 1

What is HCPCS code G9520?

Accepted Answer

HCPCS code G9520 is "Refract not +/- 1.0 w/in 90d". Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery

Question 2

What category is G9520 in?

Accepted Answer

G9520 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9520?

Accepted Answer

Use G9520 when billing for refract not +/- 1.0 w/in 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 G9520 covered by Medicare?

Accepted Answer

Coverage for G9520 (Refract not +/- 1.0 w/in 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 G9520?

Accepted Answer

Documentation for G9520 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).