G9223 — Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
G9223 is a HCPCS Level II code for pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%. 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
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for G9223
- Long descriptor
- Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%
- Short descriptor
- Pjp proph ordered cd4 low
- Added
- January 1, 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.
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 G9223
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9223 is not quite right, the correct code is very often within a few positions of it.
- 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
- G9221Pneumocystis jiroveci pneumonia prophlaxis prescribedterminated
- G9222Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3terminated
- 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
- G9230Chlamydia, gonorrhea, and syphilis not screened, reason not given
- G9231Documentation of end stage renal disease (esrd), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period
Questions about G9223
What is HCPCS code G9223?
G9223 is a HCPCS Level II code for pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9223?
The CMS HCPCS file marks G9223 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 G9223 paid under the physician fee schedule?
G9223 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.