G9243 — Documentation of viral load less than 200 copies/ml
G9243 is a HCPCS Level II code for documentation of viral load less than 200 copies/ml. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
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.
Physician fee schedule statusM
Measurement code. Used for reporting purposes only; never paid.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for G9243
- Long descriptor
- Documentation of viral load less than 200 copies/ml
- Short descriptor
- Doc viral load <200
- Added
- January 1, 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.
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 G9243
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9243 is not quite right, the correct code is very often within a few positions of it.
- G9235All quality actions for the applicable measures in the general surgery measures group have been performed for this patientterminated
- G9236All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patientterminated
- G9237I intend to report the general surgery measures groupterminated
- G9238I intend to report the optimizing patient exposure to ionizing radiation measures groupterminated
- G9239Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing arteriovenous fistula (avf)/arteriovenous graft (avg), time-limited trial of hemodialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons)terminated
- G9240Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiatedterminated
- G9241Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiatedterminated
- G9242Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed
- G9244Antiretroviral thereapy not prescribedterminated
- G9245Antiretroviral therapy prescribedterminated
- G9246Patient did not have two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart
- G9247Patient had two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apart
- G9248Patient did not have a medical visit in the last 6 monthsterminated
- G9249Patient had a medical visit in the last 6 monthsterminated
- G9250Documentation of patient pain brought to a comfortable level within 48 hours from initial assessmentterminated
- G9251Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessmentterminated
Questions about G9243
What is HCPCS code G9243?
G9243 is a HCPCS Level II code for documentation of viral load less than 200 copies/ml. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9243?
The CMS HCPCS file marks G9243 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.
How is G9243 paid under the physician fee schedule?
G9243 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.