Question 1

What is HCPCS code G9936?

Accepted Answer

HCPCS code G9936 is "Pmh plyp/neo co/rect/jun/ans". Surveillance colonoscopy - personal history of colonic polyps, colon cancer, or other malignant neoplasm of rectum, rectosigmoid junction, and anus

Question 2

What category is G9936 in?

Accepted Answer

G9936 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9936?

Accepted Answer

Use G9936 when billing for pmh plyp/neo co/rect/jun/ans. 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 G9936 covered by Medicare?

Accepted Answer

Coverage for G9936 (Pmh plyp/neo co/rect/jun/ans) 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 G9936?

Accepted Answer

Documentation for G9936 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).