G9219 HCPCS - PNEUMOCYSTIS JIROVECI PNEUMONIA PROPHYLAXIS NOT PRESCRIBED WITHIN 3 MONTHS OF LOW CD4+ CELL COUNT BELOW 200 CELLS/MM3 FOR MEDICAL REASON (I.E., PATIENT'S CD4+ CELL COUNT ABOVE THRESHOLD WITHIN 3 MONTHS AFTER CD4+ CELL COUNT BELOW THRESHOLD, INDICATING THAT THE PATIENT'S CD4+ LEVELS ARE WITHIN AN ACCEPTABLE RANGE AND THE PATIENT DOES NOT REQUIRE PCP PROPHYLAXIS)

Code Information

HCPCS Code: G9219

Sequence Number: 0010

Short Description: No oder pjp for med reason

Long Description: Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)

Code Added Date: 1/1/2014

Action Code: N - No maintenance for this code

Action Effective Date: 1/1/2017

Classification: Temporary Procedures & Professional Services

Coding System: HCPCS

Code Type

Berenson-Eggers Type Of Service Code: M5B - Specialist - psychiatry
Type Of Service Code:
  • 1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96

Billing Information

Pricing Indicator Code:
  • 00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
Multiple Pricing Indicator Code: 9 - Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
Coverage Issues Manual Reference Section Number:
    N/A
    Medicare Carriers Manual Reference Section Number:
      N/A
      Coverage Code: C - Carrier judgment

      HCPCS Record

      Field Name Field Value
      Healthcare Common Procedure Coding System Code G9219
      HCPCS Sequence Number 0010
      HCPCS Record Identification Code 3 - First line of procedure record also contains detail information in positions 92-275
      HCPCS Long Description Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)
      HCPCS Short Description No oder pjp for med reason
      HCPCS Pricing Indicator Code 1 00 - Service not separately priced by part B (e.G., services not covered, bundled, used by part a only, etc.)
      HCPCS Multiple Pricing Indicator Code 9 - Not applicable as HCPCS not priced separately by part B (pricing indicator is 00) or value is not established (pricing indicator is '99')
      HCPCS Coverage Code C - Carrier judgment
      HCPCS Berenson-Eggers Type Of Service Code M5B - Specialist - psychiatry
      HCPCS Type Of Service Code 1 1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96
      HCPCS Anesthesia Base Unit Quantity 0
      HCPCS Code Added Date 1/1/2014
      HCPCS Action Effective Date 1/1/2017
      HCPCS Termination Date 12/31/2016
      HCPCS Action Code N - No maintenance for this code

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      This page was last updated on: 1/1/2018