Question 1

What is HCPCS code G9974?

Accepted Answer

HCPCS code G9974 is "Mac exam perf". Dilated macular exam performed, including documentation of the presence or absence of macular thickening or geographic atrophy or hemorrhage and the level of macular degeneration severity

Question 2

What category is G9974 in?

Accepted Answer

G9974 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9974?

Accepted Answer

Use G9974 when billing for mac exam perf. 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 G9974 covered by Medicare?

Accepted Answer

Coverage for G9974 (Mac exam perf) 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 G9974?

Accepted Answer

Documentation for G9974 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).