G9246 HCPCS Level II code: 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 the HCPCS 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” in CMS’s October 2026 release, in effect from Oct 1, 2026.
Official description
G9246Patient 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 description: No enc or enc/vir ld 90days
HCPCS · United States
Medicare details
The indicators CMS publishes with G9246 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 G9246 sits
- 1G codesProcedures and professional services
- 2Active code G9246Patient 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
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 G9246 mean?
G9246 is the HCPCS 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” in CMS’s HCPCS Level II October 2026 release.
Does Medicare cover G9246?
CMS lists G9246’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 G9246
All G codesG9240Patient 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 initiatedG9242Documentation of viral load equal to or greater than 200 copies/ml or viral load not performedG9243Documentation of viral load less than 200 copies/mlG9244Antiretroviral thereapy not prescribedG9245Antiretroviral therapy prescribedG9247Patient 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 monthsG9249Patient had a medical visit in the last 6 monthsG9250Documentation of patient pain brought to a comfortable level within 48 hours from initial assessmentG9251Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessmentG9252Adenoma(s) or other neoplasm detected during screening colonoscopy