Summary & Overview
HCPCS G9020: Rimantadine Hydrochloride, Oral, 100 mg
HCPCS Level II code G9020 identifies rimantadine hydrochloride, oral, per 100 mg, designated for use within Medicare-approved demonstration projects. This code is relevant nationally for providers and payers engaged in clinical demonstration programs that supply investigational or state-run antiviral therapies under Medicare oversight. It matters because demonstration-project drugs often follow special coverage, billing, and data-collection pathways that differ from routine outpatient pharmacy claims.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical purpose, typical service setting, and how it is categorized within HCPCS Level II coding. The publication outlines expected billing contexts, common implementation considerations for demonstration-project medications, and links to policy and coverage implications at a national level. Benchmarks and payer-specific handling are summarized where available; where input data is absent, the report notes "Data not available in the input." The content equips billing managers, compliance officers, and clinical program leads with a clear reference to the code’s intended use and operational context within demonstration projects.
Billing Code Overview
HCPCS Level II code G9020 represents rimantadine hydrochloride, oral, per 100 mg, supplied for use in a Medicare-approved demonstration project. The service type is oral antiviral medication administration/supply for investigational or demonstration use. The typical site of service is outpatient or ambulatory settings where study medications are dispensed or administered, including clinic infusion/pharmacy dispensing areas and outpatient research clinics.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical scenario involves an adult patient enrolled in a Medicare-approved influenza antiviral demonstration project presenting for oral antiviral therapy during a public health influenza season. The patient has confirmed or strongly suspected influenza A infection based on rapid testing or clinical assessment and has been evaluated in an outpatient clinic or public health clinic participating in the demonstration. A clinician (family medicine physician, internal medicine physician, or public health nurse practitioner) documents the indication, obtains informed consent for participation in the demonstration project, and dispenses or prescribes rimantadine hydrochloride in 100 mg oral tablets. Medication administration or dispensing is recorded in the medical record, with documentation of dosage, number of tablets, start date, and counseling on side effects and contraindications. Typical sites of service include outpatient clinic, public health clinic, community health center, and potentially home health visits when provided under the demonstration project protocol. Common patient characteristics include adults at risk for complications from influenza A, residents of long-term care facilities, or patients for whom other antivirals are contraindicated or unavailable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service | Use when a distinct E/M visit is performed the same day as dispensing or administration of medication and must be reported separately. |