HCPCS Level II · Procedures and professional services (temporary)
G9216Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
Terminated 12/31/2014
Source: CMS HCPCS quarterly update, October 2026. Page updated September 29, 2026.
About G9216
G9216 is an HCPCS Level II code in the G series (procedures and professional services (temporary)), describing pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given.
It was added to HCPCS effective 01/01/2014, and its current record took effect 01/01/2015.
It was terminated on 12/31/2014 and can't be billed for later dates of service.
Its Medicare coverage code is "C", meaning coverage is left to the Medicare contractor's judgment.
Details
- Short description
- No pcp proph at dx no reason
- Date added
- 01/01/2014
- Action effective
- 01/01/2015
- Termination date
- 12/31/2014
- BETOS
- M5B
Related G92xx codes
- G9212Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation
- G9213Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified
- G9223Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
- G9225Foot exam was not performed, reason not given
- G9226Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed)
- G9227Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter
- G9228Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings)
- G9230Chlamydia, gonorrhea, and syphilis not screened, reason not given
- G9231Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period
- G9242Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed
- G9243Documentation of viral load less than 200 copies/ml
- G9246Patient did not have two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart
Common questions about G9216
Is HCPCS G9216 still valid?
- No. G9216 was terminated on 12/31/2014.
Does Medicare cover G9216?
- Its coverage code is "C": coverage is left to the Medicare contractor's judgment. Check the local coverage determination for your region.