Question 1

What is HCPCS code G9454?

Accepted Answer

HCPCS code G9454 is "No scr hcv inf 12 mth rp". One-time screening for hcv infection not received within 12-month reporting period and no documentation of prior screening for hcv infection, reason not given

Question 2

What category is G9454 in?

Accepted Answer

G9454 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9454?

Accepted Answer

Use G9454 when billing for no scr hcv inf 12 mth rp. 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 G9454 covered by Medicare?

Accepted Answer

Coverage for G9454 (No scr hcv inf 12 mth rp) 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 G9454?

Accepted Answer

Documentation for G9454 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).