G9522 — Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given
G9522 is a HCPCS Level II code for total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given. 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
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The CMS record for G9522
- Long descriptor
- Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given
- Short descriptor
- Er/ip hosp =/>2 in 12 mos
- 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 G9522
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9522 is not quite right, the correct code is very often within a few positions of it.
- 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
- G9523Patient discontinued from hemodialysis or peritoneal dialysisterminated
- G9524Patient was referred to hospice careterminated
- G9525Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)terminated
- G9526Patient was not referred to hospice care, reason not giventerminated
- G9529Patient with minor blunt head trauma had an appropriate indication(s) for a head ct
- G9530Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
- G9531Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar
- G9532Patient had a head ct for trauma ordered by someone other than an emergency care provider or was ordered for a reason other than traumaterminated
Questions about G9522
What is HCPCS code G9522?
G9522 is a HCPCS Level II code for total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9522?
The CMS HCPCS file marks G9522 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 G9522 paid under the physician fee schedule?
G9522 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.