G9506 — Biologic immune response modifier prescribed
G9506 is a HCPCS Level II code for biologic immune response modifier prescribed. It belongs to the Procedures and Professional Services (Temporary) section. It was terminated on December 31, 2022 and is not valid on new claims.
This code has been terminated
CMS terminated G9506 on December 31, 2022. 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 G9506
- Long descriptor
- Biologic immune response modifier prescribed
- Short descriptor
- Bio imm resp mod presc
- Added
- January 1, 2016
- Terminated
- December 31, 2022
- BETOS
- Z2
- 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 G9506
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9506 is not quite right, the correct code is very often within a few positions of it.
- G9498Antibiotic regimen prescribed
- G9499Patient did not start or is not receiving antiviral treatment for hepatitis c during the measurement periodterminated
- G9500Radiation exposure indices documented in final report for procedure using fluoroscopy
- G9501Radiation exposure indices not documented in final report for procedure using fluoroscopy, reason not given
- G9502Documentation of medical reason for not performing foot exam (i.e., patients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement period)
- G9503Patient taking tamsulosin hydrochlorideterminated
- G9504Documented reason for not assessing hepatitis b virus (hbv) status (e.g., patient not initiating anti-tnf therapy, patient declined) prior to initiating anti-tnf therapy
- G9505Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
- G9507Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myostitis or toxic myopathy related to drugs)
- G9508Documentation that the patient is not on a statin medication
- G9509Adult patients 18 years of age or older with major depression or dysthymia who reached remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5
- G9510Adult patients 18 years of age or older with major depression or dysthymia who did not reach remission at twelve months as demonstrated by a twelve month (+/-60 days) phq-9 or phq-9m score of less than 5. either phq- 9 or phq-9m score was not assessed or is greater than or equal to 5
- G9511Index event date phq-9 or phq-9m score greater than 9 documented during the twelve month denominator identification period
- G9512Individual had a pdc of 0.8 or greater
- G9513Individual did not have a pdc of 0.8 or greater
- G9514Patient required a return to the operating room within 90 days of surgery
Questions about G9506
What is HCPCS code G9506?
G9506 is a HCPCS Level II code for biologic immune response modifier prescribed. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9506?
The CMS HCPCS file marks G9506 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 G9506 still valid?
No. G9506 was terminated on December 31, 2022 and should not be used on new claims.