G9246 — Patient 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
G9246 is a HCPCS Level II code for patient 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. 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 G9246
- Long descriptor
- Patient 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
- Short descriptor
- No enc or enc/vir ld 90days
- 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 G9246
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9246 is not quite right, the correct code is very often within a few positions of it.
- 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
- G9243Documentation of viral load less than 200 copies/ml
- G9244Antiretroviral thereapy not prescribedterminated
- G9245Antiretroviral therapy prescribedterminated
- 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
- G9252Adenoma(s) or other neoplasm detected during screening colonoscopyterminated
- G9253Adenoma(s) or other neoplasm not detected during screening colonoscopyterminated
- G9254Documentation of patient discharged to home later than post-operative day 2 following cea or cas
Questions about G9246
What is HCPCS code G9246?
G9246 is a HCPCS Level II code for patient 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. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9246?
The CMS HCPCS file marks G9246 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 G9246 paid under the physician fee schedule?
G9246 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.