Question 1

What is HCPCS code G9804?

Accepted Answer

HCPCS code G9804 is "Pt not presc 135 day trmt". Patient was not prescribed at least a 135 day treatment within the 180-day measurement interval with beta-blockers post-discharge for ami

Question 2

What category is G9804 in?

Accepted Answer

G9804 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9804?

Accepted Answer

Use G9804 when billing for pt not presc 135 day trmt. 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 G9804 covered by Medicare?

Accepted Answer

Coverage for G9804 (Pt not presc 135 day trmt) 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 G9804?

Accepted Answer

Documentation for G9804 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).