G9204 HCPCS code: Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
G9204 is the HCPCS Level II code for rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given. CMS terminated G9204 on 2016-12-31; do not bill it for later dates of service. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | M5B |
| Added | 2014-01-01 |
| Last action effective | 2017-01-01 |
| Terminated | 2016-12-31 |
What changed for G9204
- 2014-01-01: G9204 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G9204?
G9204 is the HCPCS Level II code for rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given. Short descriptor: "No reason for no hep c rna".
Does Medicare cover G9204?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G92 codes
- G9200 — Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given
- G9201 — Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission
- G9202 — Patients with a positive hepatitis c antibody test
- G9203 — Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
- G9205 — Patient starting antiviral treatmentfor hepatitis c during the measurement period
- G9206 — Patient starting antiviral treatment for hepatitis c during the measurement period
- G9207 — Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c
- G9208 — Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given
- G9209 — Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment
- G9210 — Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for documented reason(s) (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons)
- G9211 — Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given
- G9212 — Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation
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Next steps
- Run a reimbursement report for a device billed under G9204
- Watch G9204 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G9204
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.