G9220 HCPCS - PNEUMOCYSTIS JIROVECI PNEUMONIA PROPHYLAXIS NOT PRESCRIBED WITHIN 3 MONTHS OF LOW CD4+ CELL COUNT BELOW 500 CELLS/MM3 OR A CD4 PERCENTAGE BELOW 15% 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: G9220
Sequence Number: 0010
Short Description: No order for pjp for medrsn
Long Description: Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% 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)
Date Added: 1/1/2014
Action Code: N - No maintenance for this code
Action Effective Date: 1/1/2015
Classification: Temporary Procedures & Professional Services
Coding System: HCPCS

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

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

Field Name	Field Value
Healthcare Common Procedure Coding System Code	G9220
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 500 cells/mm3 or a cd4 percentage below 15% 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 order for pjp for medrsn
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	1/1/2015
HCPCS Termination Date	12/31/2014
HCPCS Action Code	N - No maintenance for this code