G9216 — Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
G9216 is a HCPCS Level II code for pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given. It belongs to the Procedures and Professional Services (Temporary) section. It was terminated on December 31, 2014 and is not valid on new claims.
This code has been terminated
CMS terminated G9216 on December 31, 2014. It stays in the file as history — a claim you are auditing from before that date may legitimately carry it — but it must not appear on a new claim. The adjacent codes below are the usual place to look for its replacement.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
The CMS record for G9216
- Long descriptor
- Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
- Short descriptor
- No pcp proph at dx no reason
- Added
- January 1, 2014
- Terminated
- December 31, 2014
- BETOS
- M5B
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
When CMS retired it.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to G9216
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9216 is not quite right, the correct code is very often within a few positions of it.
- G9208Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not giventerminated
- G9209Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatmentterminated
- G9210Hepatitis 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)terminated
- G9211Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not giventerminated
- G9212Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation
- G9213Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified
- G9214Cd4+ cell count or cd4+ cell percentage results documentedterminated
- G9215Cd4+ cell count or percentage not documented as performed, reason not giventerminated
- G9217Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not giventerminated
- G9218Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not giventerminated
- G9219Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)terminated
- G9220Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)terminated
- G9221Pneumocystis jiroveci pneumonia prophlaxis prescribedterminated
- G9222Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3terminated
- G9223Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
- G9224Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)terminated
Questions about G9216
What is HCPCS code G9216?
G9216 is a HCPCS Level II code for pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9216?
The CMS HCPCS file marks G9216 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
Is G9216 still valid?
No. G9216 was terminated on December 31, 2014 and should not be used on new claims.