Question 1

What is HCPCS code G9811?

Accepted Answer

HCPCS code G9811 is "No pdc 75% w/asth cont med". Patient did not achieve a pdc of at least 75% for their asthma controller medication

Question 2

What category is G9811 in?

Accepted Answer

G9811 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9811?

Accepted Answer

Use G9811 when billing for no pdc 75% w/asth cont med. 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 G9811 covered by Medicare?

Accepted Answer

Coverage for G9811 (No pdc 75% w/asth cont med) 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 G9811?

Accepted Answer

Documentation for G9811 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).