G9521 HCPCS code: Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months

G9521 is the HCPCS Level II code for total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.

Code details

What changed for G9521

• 2016-01-01: G9521 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 G9521?

G9521 is the HCPCS Level II code for total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months. Short descriptor: "Er and ip hosp <2 in 12 mos".

Does Medicare cover G9521?

Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.

Related G95 codes

• G9500 — Radiation exposure indices documented in final report for procedure using fluoroscopy
• G9501 — Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given
• G9502 — Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period)
• G9503 — Patient taking tamsulosin hydrochloride
• G9504 — Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy
• G9505 — Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
• G9506 — Biologic immune response modifier prescribed
• G9507 — Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)
• G9508 — Documentation that the patient is not on a statin medication
• G9509 — Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
• G9510 — Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5
• G9511 — Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period

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Next steps

• Run a reimbursement report for a device billed under G9521
• Watch G9521 for fee, coverage and descriptor changes
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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.

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