G9506 – Biologic immune response modifier prescribed

Long description

Biologic immune response modifier prescribed

Short description

Bio imm resp mod presc

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

Z2 Undefined codes

Added

January 1, 2016

Last change

January 1, 2023 – No change

Termination date

December 31, 2022

Nearby G codes

• G9498 – Antibiotic regimen prescribed
• G9499 – Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement period
• G9500 – Radiation exposure indices documented in final report for procedure using fluoroscopy
• G9501 – Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given
• G9502 – Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period)
• G9503 – Patient taking tamsulosin hydrochloride
• G9504 – Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy
• G9505 – Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
• G9507 – Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)
• G9508 – Documentation that the patient is not on a statin medication
• G9509 – Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
• G9510 – Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5
• G9511 – Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period
• G9512 – Individual had a pdc of 0.8 or greater
• G9513 – Individual did not have a pdc of 0.8 or greater
• G9514 – Patient required a return to the operating room within 90 days of surgery