G9521 — Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months
G9521 is a HCPCS Level II code for total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months. 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 G9521
- Long descriptor
- Total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months
- Short descriptor
- Er and ip hosp <2 in 12 mos
- Added
- January 1, 2016
- 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.
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 G9521
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9521 is not quite right, the correct code is very often within a few positions of it.
- G9513Individual did not have a pdc of 0.8 or greater
- G9514Patient required a return to the operating room within 90 days of surgery
- G9515Patient did not require a return to the operating room within 90 days of surgery
- G9516Patient achieved an improvement in visual acuity, from their preoperative level, within 90 days of surgery
- G9517Patient did not achieve an improvement in visual acuity, from their preoperative level, within 90 days of surgery, reason not given
- G9518Documentation of active injection drug use
- G9519Patient achieves final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
- G9520Patient does not achieve final refraction (spherical equivalent) +/- 1.0 diopters of their planned refraction within 90 days of surgery
- G9522Total number of emergency department visits and inpatient hospitalizations equal to or greater than two in the past 12 months or patient not screened, reason not given
- G9523Patient discontinued from hemodialysis or peritoneal dialysisterminated
- G9524Patient was referred to hospice careterminated
- G9525Documentation of patient reason(s) for not referring to hospice care (e.g., patient declined, other patient reasons)terminated
- G9526Patient was not referred to hospice care, reason not giventerminated
- G9529Patient with minor blunt head trauma had an appropriate indication(s) for a head ct
- G9530Patient presented with a minor blunt head trauma and had a head ct ordered for trauma by an emergency care provider
- G9531Patient has documentation of ventricular shunt, brain tumor, multisystem trauma, or is currently taking an antiplatelet medication including: abciximab, anagrelide, cangrelor, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticlopidine, ticagrelor, tirofiban, or vorapaxar
Questions about G9521
What is HCPCS code G9521?
G9521 is a HCPCS Level II code for total number of emergency department visits and inpatient hospitalizations less than two in the past 12 months. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9521?
The CMS HCPCS file marks G9521 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 G9521 paid under the physician fee schedule?
G9521 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.