G9221 — Pneumocystis jiroveci pneumonia prophlaxis prescribed
G9221 is a HCPCS Level II code for pneumocystis jiroveci pneumonia prophlaxis prescribed. It belongs to the Procedures and Professional Services (Temporary) section. It was terminated on December 31, 2014 and is not valid on new claims.
This code has been terminated
CMS terminated G9221 on December 31, 2014. It stays in the file as history — a claim you are auditing from before that date may legitimately carry it — but it must not appear on a new claim. The adjacent codes below are the usual place to look for its replacement.
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.
The CMS record for G9221
- Long descriptor
- Pneumocystis jiroveci pneumonia prophlaxis prescribed
- Short descriptor
- Pjp proph prescribed
- Added
- January 1, 2014
- Terminated
- December 31, 2014
- BETOS
- M5B
- 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.
When CMS retired it.
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 G9221
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9221 is not quite right, the correct code is very often within a few positions of it.
- G9213Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified
- G9214Cd4+ cell count or cd4+ cell percentage results documentedterminated
- G9215Cd4+ cell count or percentage not documented as performed, reason not giventerminated
- G9216Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not giventerminated
- G9217Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3, reason not giventerminated
- G9218Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not giventerminated
- G9219Pneumocystis 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 threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)terminated
- 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., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis)terminated
- G9222Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3terminated
- G9223Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
- G9224Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation)terminated
- G9225Foot exam was not performed, reason not given
- G9226Foot examination performed (includes examination through visual inspection, sensory exam with 10-g monofilament plus testing any one of the following: vibration using 128-hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold, and pulse exam; report when all of the 3 components are completed)
- G9227Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan at the time of the encounter
- G9228Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings)
- G9229Chlamydia, gonorrhea, and syphilis screening results not documented (patient refusal is the only allowed exception)terminated
Questions about G9221
What is HCPCS code G9221?
G9221 is a HCPCS Level II code for pneumocystis jiroveci pneumonia prophlaxis prescribed. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9221?
The CMS HCPCS file marks G9221 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.
Is G9221 still valid?
No. G9221 was terminated on December 31, 2014 and should not be used on new claims.