Question 1

What is HCPCS code G9522?

Accepted Answer

HCPCS code G9522 is "Er/ip hosp =/>2 in 12 mos". Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given

Question 2

What category is G9522 in?

Accepted Answer

G9522 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9522?

Accepted Answer

Use G9522 when billing for er/ip hosp =/>2 in 12 mos. 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 G9522 covered by Medicare?

Accepted Answer

Coverage for G9522 (Er/ip hosp =/>2 in 12 mos) 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 G9522?

Accepted Answer

Documentation for G9522 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).