How To Use HCPCS Code G9991

HCPCS code G9991 describes the administration of any pneumococcal conjugate or polysaccharide vaccine to a patient who is 19 years of age or older. This code is used to identify and bill for the administration of the vaccine, which helps protect against pneumococcal infections.

1. What is HCPCS G9991?

HCPCS code G9991 is a specific code used in medical coding to identify the administration of pneumococcal vaccines to patients who are 19 years of age or older. It is important to use this code accurately to ensure proper billing and reimbursement for the service provided.

2. Official Description

The official description of HCPCS code G9991 is “Patient received any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period.” The short description for this code is “Pneum vax admin 19+.”

3. Procedure

1. The healthcare provider will assess the patient’s eligibility for the pneumococcal vaccine based on their age and medical history.
2. If the patient meets the criteria for vaccination, the provider will prepare the vaccine according to the manufacturer’s instructions.
3. The provider will then administer the vaccine to the patient, following proper injection techniques and safety protocols.
4. After the administration, the provider will document the details of the vaccination, including the date, dosage, and any adverse reactions or side effects.

4. When to use HCPCS code G9991

HCPCS code G9991 should be used when a patient receives any pneumococcal conjugate or polysaccharide vaccine on or after their 19th birthday and before the end of the measurement period. It is important to ensure that the patient meets the age requirement and that the vaccine is administered within the specified timeframe.

5. Billing Guidelines and Documentation Requirements

When billing for the administration of pneumococcal vaccines using HCPCS code G9991, healthcare providers should ensure that the following documentation requirements are met:

• Documentation of the patient’s age and eligibility for the vaccine
• Date of administration
• Type and dosage of the vaccine administered
• Any adverse reactions or side effects observed

Providers should also follow the appropriate billing guidelines and submit the claim with the necessary supporting documentation to ensure accurate reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9991 was added to the Healthcare Common Procedure Coding System on January 01, 2022. The long description of the procedure or modifier code was changed, indicating a modification to the code’s description. The effective date of this change is January 01, 2024. There have been no pricing changes or maintenance actions taken for this code, as indicated by the pricing indicator code of 00 and the multiple pricing indicator code of 9.

7. Medicare and Insurance Coverage

Medicare and other insurance providers may cover the administration of pneumococcal vaccines using HCPCS code G9991. However, the pricing indicator code of 00 indicates that the service is not separately priced by Part B. This means that the reimbursement for the service may be bundled or included in other services provided during the same encounter. Healthcare providers should verify the coverage and reimbursement policies of each specific payer to ensure proper billing and reimbursement.

8. Examples

Here are some examples of when HCPCS code G9991 should be billed:

1. A 45-year-old patient visits their primary care physician for a routine check-up. During the visit, the physician administers a pneumococcal vaccine to the patient. HCPCS code G9991 should be used to bill for the administration of the vaccine.
2. An 80-year-old patient is admitted to the hospital for a surgical procedure. As part of the pre-operative care, the patient receives a pneumococcal vaccine. HCPCS code G9991 should be used to bill for the administration of the vaccine.
3. A 65-year-old patient visits a pharmacy for a flu shot and also receives a pneumococcal vaccine during the same visit. HCPCS code G9991 should be used to bill for the administration of the pneumococcal vaccine.
4. A 70-year-old patient receives a pneumococcal vaccine at a community health fair organized by a local healthcare organization. HCPCS code G9991 should be used to bill for the administration of the vaccine.
5. A 55-year-old patient visits a travel clinic before embarking on an international trip. As part of the travel vaccinations, the patient receives a pneumococcal vaccine. HCPCS code G9991 should be used to bill for the administration of the vaccine.