G9242 HCPCS Level II code: Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed
G9242 is the HCPCS code for “Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
G9242Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed
Short description: Doc viral load >=200
HCPCS · United States
Medicare details
The indicators CMS publishes with G9242 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
Where G9242 sits
- 1G codesProcedures and professional services
- 2Active code G9242Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed
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
What does HCPCS code G9242 mean?
G9242 is the HCPCS code for “Documentation of viral load equal to or greater than 200 copies/ml or viral load not performed” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover G9242?
CMS lists G9242’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 G9242
All G codesG9236All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patientG9237I intend to report the general surgery measures groupG9238I intend to report the optimizing patient exposure to ionizing radiation measures groupG9239Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing arteriovenous fistula…G9240Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiatedG9241Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiatedG9243Documentation of viral load less than 200 copies/mlG9244Antiretroviral thereapy not prescribedG9245Antiretroviral therapy prescribedG9246Patient 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 apartG9247Patient had two eligible encounters at least 90 days apart or one eligible encounter and one hiv viral load test at least 90 days apartG9248Patient did not have a medical visit in the last 6 months