Question 1

What is HCPCS code G9247?

Accepted Answer

HCPCS code G9247 is "2 enc enc/vir ld 90d". Patient had two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart

Question 2

What category is G9247 in?

Accepted Answer

G9247 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9247?

Accepted Answer

Use G9247 when billing for 2 enc enc/vir ld 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 G9247 covered by Medicare?

Accepted Answer

Coverage for G9247 (2 enc enc/vir ld 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 G9247?

Accepted Answer

Documentation for G9247 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).