How To Use HCPCS Code G9035

HCPCS code G9035 describes the oral medication Oseltamivir phosphate, brand, per 75 mg, which is used in a Medicare-approved demonstration project. This code was terminated on December 31, 2019, and is no longer maintained. In this article, we will explore the details of HCPCS code G9035, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G9035?

HCPCS code G9035 is used to identify the oral medication Oseltamivir phosphate, brand, per 75 mg. It specifically refers to the use of this medication in a Medicare-approved demonstration project. This code is no longer maintained and was terminated on December 31, 2019.

2. Official Description

The official description of HCPCS code G9035 is “Oseltamivir phosphate, oral, brand, per 75 mg (for use in a Medicare-approved demonstration project).” The short description for this code is “Oseltamivir phosp, brand.”

3. Procedure

1. Before administering the medication, the healthcare provider should verify the patient’s eligibility for the Medicare-approved demonstration project.
2. Calculate the appropriate dosage of Oseltamivir phosphate based on the patient’s weight and condition.
3. Administer the medication orally, ensuring that the patient follows the prescribed dosage instructions.
4. Monitor the patient for any potential side effects or adverse reactions.
5. Document the administration of Oseltamivir phosphate in the patient’s medical record.

4. When to use HCPCS code G9035

HCPCS code G9035 should be used when administering Oseltamivir phosphate, brand, per 75 mg, as part of a Medicare-approved demonstration project. It is important to ensure that the patient meets the eligibility criteria for the project before using this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9035, healthcare providers should ensure that the following documentation is included:

• Proof of the patient’s eligibility for the Medicare-approved demonstration project.
• Documentation of the patient’s weight and condition to calculate the appropriate dosage of Oseltamivir phosphate.
• Documentation of the administration of the medication, including the dosage and any observed side effects or adverse reactions.

6. Historical Information and Code Maintenance

HCPCS code G9035 was added to the Healthcare Common Procedure Coding System on December 01, 2004. It was terminated on December 31, 2019, and is no longer maintained. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G9035 is not separately priced by Medicare. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. It may be bundled with other services or used exclusively by Part A. The multiple pricing indicator code is 9, which indicates that the value for pricing this code is not established. It is important to check with Medicare and other insurance providers for specific coverage and reimbursement information.

8. Examples

Here are five examples of when HCPCS code G9035 should be billed:

1. A patient who meets the eligibility criteria for the Medicare-approved demonstration project receives a prescription for Oseltamivir phosphate, brand, per 75 mg, and the medication is administered as part of their treatment plan.
2. A healthcare provider participates in a Medicare-approved demonstration project and administers Oseltamivir phosphate, brand, per 75 mg, to eligible patients as part of the project.
3. A patient is enrolled in a Medicare-approved demonstration project and receives Oseltamivir phosphate, brand, per 75 mg, as prescribed by their healthcare provider.
4. A healthcare facility participates in a Medicare-approved demonstration project and provides Oseltamivir phosphate, brand, per 75 mg, to eligible patients as part of their services.
5. A healthcare provider documents the administration of Oseltamivir phosphate, brand, per 75 mg, as part of a patient’s participation in a Medicare-approved demonstration project.