Question 1

What is HCPCS code G9938?

Accepted Answer

HCPCS code G9938 is "Pt 66+ snp or ltc pos > 90d". Patients aged 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54, or 56 for more than 90 consecutive days during the six months prior to the measurement period through december 31 of the measurement period

Question 2

What category is G9938 in?

Accepted Answer

G9938 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9938?

Accepted Answer

Use G9938 when billing for pt 66+ snp or ltc pos > 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 G9938 covered by Medicare?

Accepted Answer

Coverage for G9938 (Pt 66+ snp or ltc pos > 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 G9938?

Accepted Answer

Documentation for G9938 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).