G9513 — Individual did not have a pdc of 0.8 or greater
G9513 is a HCPCS Level II code for individual did not have a pdc of 0.8 or greater. 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 G9513
- Long descriptor
- Individual did not have a pdc of 0.8 or greater
- Short descriptor
- Indiv pdc not > 0.8
- Added
- January 1, 2016
- BETOS
- Z2
- 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 G9513
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9513 is not quite right, the correct code is very often within a few positions of it.
- G9505Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
- G9506Biologic immune response modifier prescribedterminated
- G9507Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)
- G9508Documentation that the patient is not on a statin medication
- G9509Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
- G9510Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5
- G9511Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period
- G9512Individual had a pdc of 0.8 or greater
- G9514Patient required a return to the operating room within 90 days of surgery
- G9515Patient did not require a return to the operating room within 90 days of surgery
- G9516Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery
- G9517Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given
- G9518Documentation of active injection drug use
- G9519Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
- G9520Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
- G9521Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months
Questions about G9513
What is HCPCS code G9513?
G9513 is a HCPCS Level II code for individual did not have a pdc of 0.8 or greater. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9513?
The CMS HCPCS file marks G9513 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 G9513 paid under the physician fee schedule?
G9513 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.