G9536 HCPCS - DOCUMENTATION OF MEDICAL REASON(S) FOR ORDERING AN ADVANCED BRAIN IMAGING STUDY (I.E., PATIENT HAS AN ABNORMAL NEUROLOGICAL EXAMINATION; PATIENT HAS THE COEXISTENCE OF SEIZURES, OR BOTH; RECENT ONSET OF SEVERE HEADACHE; CHANGE IN THE TYPE OF HEADACHE; SIGNS OF INCREASED INTRACRANIAL PRESSURE (E.G., PAPILLEDEMA, ABSENT VENOUS PULSATIONS ON FUNDUSCOPIC EXAMINATION, ALTERED MENTAL STATUS, FOCAL NEUROLOGIC DEFICITS, SIGNS OF MENINGEAL IRRITATION); HIV-POSITIVE PATIENTS WITH A NEW TYPE OF HEADACHE; IMMUNOCOMPROMISED PATIENT WITH UNEXPLAINED HEADACHE SYMPTOMS; PATIENT ON COAGULOPATHY/ANTI-COAGULATION OR ANTI-PLATELET THERAPY; VERY YOUNG PATIENTS WITH UNEXPLAINED HEADACHE SYMPTOMS)

Code Information

HCPCS Code: G9536
Sequence Number: 0010
Short Description: Doc med reas adv brain image
Long Description: Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms)
Date Added: 1/1/2016
Action Code: N - No maintenance for this code
Action Effective Date: 1/1/2019
Classification: Temporary Procedures & Professional Services
Coding System: HCPCS

Code Type

Berenson-Eggers Type Of Service Code: Z2 - Undefined codes
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	G9536
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	Documentation of medical reason(s) for ordering an advanced brain imaging study (i.e., patient has an abnormal neurological examination; patient has the coexistence of seizures, or both; recent onset of severe headache; change in the type of headache; signs of increased intracranial pressure (e.g., papilledema, absent venous pulsations on funduscopic examination, altered mental status, focal neurologic deficits, signs of meningeal irritation); hiv-positive patients with a new type of headache; immunocompromised patient with unexplained headache symptoms; patient on coagulopathy/anti-coagulation or anti-platelet therapy; very young patients with unexplained headache symptoms)
HCPCS Short Description	Doc med reas adv brain image
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	Z2 - Undefined codes
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	1/1/2016
HCPCS Action Effective Date	1/1/2019
HCPCS Termination Date	12/31/2018
HCPCS Action Code	N - No maintenance for this code

Code Information

Code Type

Billing Information

HCPCS Record

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