G9216 HCPCS Level II code: Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
CMS terminated G9216: its last date of service was Dec 31, 2014. It stays here for looking up older claims; newer services need a current code.
Official description
G9216Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
Short description: No pcp proph at dx no reason
HCPCS · United States
Medicare details
The indicators CMS publishes with G9216 in its October 2026 file. They describe Medicare’s handling, not another payer’s.
- Medicare coverage
- Carrier judgment
- Medicare pricing
- Service not separately priced by Part B (e.g., services not covered, bundled, used by Part A only, etc.)
- Type of service
- Medical care
- BETOS category
- Specialist - psychiatry
- Added
- Jan 1, 2014
- Terminated after
- Dec 31, 2014
Where G9216 sits
- 1G codesProcedures and professional services
- 2Terminated G9216Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given
Source and release
- Data release
- HCPCS Level II · October 2026
- Effective date
- Oct 1, 2026
- Publisher
- CMS
This page is built from the HCPCS Level II catalog that Vero Codes reads when it suggests codes: Centers for Medicare & Medicaid Services’s October 2026 release, imported from the publisher’s file and checked against it. The description, notes and structured data come from the same record.
Frequently asked questions
Is HCPCS code G9216 still valid?
No. CMS terminated G9216; its last date of service was Dec 31, 2014. It is listed for looking up services from before then. Use a current code for newer services.
Does Medicare cover G9216?
CMS lists G9216’s Medicare coverage as “Carrier judgment” and its pricing as “Service not separately priced by Part B (e.g., services not covered, bundled, used by Part A only, etc.)”. Coverage and payment still depend on the patient, the setting, the documentation and the payer.
Which HCPCS Level II release does this page use?
It uses CMS’s October 2026 release, in effect from Oct 1, 2026 to Dec 31, 2026. It is a reference: confirm the code against the current list and the payer’s rules before you submit it.
Codes beside G9216
All G codesG9210Hepatitis 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…G9211Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not givenG9212Dsm-ivtm criteria for major depressive disorder documented at the initial evaluationG9213Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specifiedG9214Cd4+ cell count or cd4+ cell percentage results documentedG9215Cd4+ cell count or percentage not documented as performed, reason not givenG9217Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not givenG9218Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not givenG9219Pneumocystis 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…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.…G9221Pneumocystis jiroveci pneumonia prophlaxis prescribedG9222Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3