G9218 – Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given

Long description

Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given

Short description

No pcp prop low at cd4 norsn

Pricing indicator

00 Not separately priced by Part B (bundled, not covered or Part A only)

Medicare coverage

C Carrier judgment – coverage decided by the Medicare contractor

BETOS category

M5B Specialist - psychiatry

Added

January 1, 2014

Last change

January 1, 2015 – No change

Termination date

December 31, 2014

Nearby G codes

• G9210 – Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for documented reason(s) (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons)
• G9211 – Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given
• G9212 – Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation
• G9213 – Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified
• G9214 – Cd4+ cell count or cd4+ cell percentage results documented
• G9215 – Cd4+ cell count or percentage not documented as performed, reason not given
• G9216 – Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
• G9217 – Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not given
• G9219 – Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
• G9220 – Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
• G9221 – Pneumocystis jiroveci pneumonia prophlaxis prescribed
• G9222 – Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3
• G9223 – Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
• G9224 – Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)
• G9225 – Foot exam was not performed, reason not given
• G9226 – Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed)