How To Use HCPCS Code G9019

HCPCS code G9019 describes the oral medication oseltamivir phosphate, which is used in a Medicare-approved demonstration project. This article will provide an in-depth understanding of HCPCS code G9019, including its official description, procedure, when to use it, billing guidelines and documentation requirements, historical information and code maintenance, Medicare and insurance coverage, and examples of when this code should be billed.

1. What is HCPCS G9019?

HCPCS code G9019 is used to identify the oral medication oseltamivir phosphate, which is administered in a dosage of 75 mg. This code is specifically used for the medication’s use in a Medicare-approved demonstration project. It is important to note that HCPCS codes are used for reporting medical procedures, services, and supplies, and G9019 specifically identifies this particular medication and its usage in a specific context.

2. Official Description

The official description of HCPCS code G9019 is “Oseltamivir phosphate, oral, per 75 mg (for use in a Medicare-approved demonstration project).” This description clearly indicates that this code is used to report the administration of oseltamivir phosphate in a specific dosage for a specific purpose, which is participation in a Medicare-approved demonstration project. The short description of this code is “Oseltamivir phosphate 75mg,” which provides a concise summary of the medication and dosage.

3. Procedure

1. The provider should verify that the patient is eligible for the Medicare-approved demonstration project in which oseltamivir phosphate is being used.
2. The provider should calculate the appropriate dosage of oseltamivir phosphate based on the patient’s weight and medical condition.
3. The provider should administer the medication orally, ensuring that the patient follows the prescribed dosage instructions.
4. The provider should document the administration of oseltamivir phosphate, including the dosage administered and any relevant patient information.

4. When to use HCPCS code G9019

HCPCS code G9019 should be used when reporting the administration of oseltamivir phosphate in a Medicare-approved demonstration project. It is important to ensure that the patient meets the eligibility criteria for participation in the project before using this code. This code should not be used for other contexts or conditions outside of the approved demonstration project.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9019, healthcare providers should ensure that they have the following documentation:

• Proof of the patient’s eligibility for the Medicare-approved demonstration project
• Documentation of the patient’s weight and medical condition
• Documentation of the dosage administered and any relevant patient information

Providers should follow the standard billing guidelines for Medicare or other insurers, ensuring that all necessary information is included in the claim submission.

6. Historical Information and Code Maintenance

HCPCS code G9019 was added to the Healthcare Common Procedure Coding System on December 01, 2004. It has a termination date of December 31, 2019. This indicates that the code was in use for a specific period and is no longer valid for reporting after the termination date. The termination of this code suggests that the Medicare-approved demonstration project for oseltamivir phosphate has concluded.

7. Medicare and Insurance Coverage

HCPCS code G9019 falls under the coverage code C, which indicates that coverage is determined by the carrier’s judgment. This means that Medicare or other insurers will assess the eligibility and coverage of oseltamivir phosphate based on their own guidelines and policies. The pricing indicator code for this code is 13, which means that the price is established by carriers and may involve individual determination or carrier discretion. The multiple pricing indicator code is A, indicating that the code is not applicable for multiple pricing methodologies.

8. Examples

Here are five examples of when HCPCS code G9019 should be billed:

1. A patient who meets the eligibility criteria for a Medicare-approved demonstration project is prescribed oseltamivir phosphate for the treatment of influenza.
2. A healthcare provider administers oseltamivir phosphate to a patient participating in a Medicare-approved demonstration project for the prevention of influenza.
3. A patient enrolled in a Medicare-approved demonstration project receives oseltamivir phosphate as part of a research study on the effectiveness of the medication in reducing influenza-related hospitalizations.
4. A healthcare provider administers oseltamivir phosphate to a patient who is part of a Medicare-approved demonstration project aimed at evaluating the medication’s impact on reducing influenza transmission in long-term care facilities.
5. A patient enrolled in a Medicare-approved demonstration project receives oseltamivir phosphate as part of a comprehensive influenza management program that includes medication, vaccination, and education.