G9207 Hepatitis C Genotype Testing Reimbursement | OpenPayer

Summary & Overview

HCPCS G9207: Hepatitis C Genotype Testing Prior to Antiviral Treatment

HCPCS Level II code G9207 represents documentation that hepatitis C genotype testing was performed within 12 months before starting antiviral therapy. Genotype determination is a clinically significant step in hepatitis C management because it informs antiviral selection and treatment duration, and documenting timely testing supports both clinical pathways and payer coverage rules.

This publication covers national payer approaches to G9207 and includes Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of what the code denotes, how payers typically treat pre-treatment genotype documentation, and the clinical context for ordering genotype testing. The analysis outlines common benchmarks and policy considerations that affect coverage and claims processing, such as timing requirements and linkage to treatment initiation.

The report is aimed at billing managers, clinical leaders, and policy analysts. It provides concise guidance on where G9207 fits in clinical workflows, the typical settings in which the service is delivered, and the types of documentation payers expect. Data not available in the input is clearly identified where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9207HCPCS Level IIhepatitis Cgenotype testingpre-treatment testinglaboratoryoutpatientclinical documentationbilling compliance

Billing Code Overview

HCPCS Level II code G9207 documents hepatitis C genotype testing performed within 12 months prior to initiation of antiviral treatment for hepatitis C. The service type is diagnostic laboratory testing / pre-treatment genotype assessment, intended to confirm viral genotype as part of treatment planning. The typical site of service is ambulatory clinic or outpatient laboratory settings where pre-treatment evaluation and specimen collection occur.

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 54-year-old patient with chronic hepatitis C virus (HCV) infection presents to a hepatology clinic for evaluation prior to initiation of direct-acting antiviral therapy. The patient has a recent laboratory order for HCV genotyping and viral load testing. The clinical workflow involves outpatient phlebotomy for HCV genotype testing, review of prior laboratory results in the electronic health record, documentation that G9207 (Hepatitis C genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis C) is satisfied, and the hepatologist proceeding with antiviral regimen selection based on genotype results. Specimen collection commonly occurs at an outpatient clinic or independent laboratory draw station; results are obtained from the laboratory information system and filed in the medical record. The documented genotype result is required for payer authorization and supports selection of drug type and treatment duration.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service	Use when a clinician provides a distinct E/M visit separate from counseling about HCV therapy on the same day as ordering or reviewing genotype testing.

HCPCS G8797: Specimen From Non-Esophageal Site

HCPCS-G8749-ABSENCE-SYSTEMIC-SIGNS-SYMPTOMS-MELANOMA-ASSESSMENT

HCPCS G8749: Absence of Signs or Symptoms of Systemic Spread of Melanoma

HCPCS-G9731-PATIENT-UNABLE-TO-COMPLETE-LEPF-PROM

HCPCS G9731: Patient Unable to Complete LEPF PROM

HCPCS-G8635-OSTEOPOROSIS-PHARMACOLOGIC-THERAPY-NOT-PRESCRIBED

HCPCS G8635: Pharmacologic Therapy for Osteoporosis Not Prescribed

HCPCS-G9004-COORDINATED-CARE-FEE-INITIAL-LOW-RISK

HCPCS G9004: Coordinated Care Fee, Risk-Adjusted Low, Initial

HCPCS-G9748-LIVING-DONOR-KIDNEY-TRANSPLANT-SCHEDULING

HCPCS G9748: Living Donor Kidney Transplant — Patient Approved and Scheduled

HCPCS-G9982-REMOTE-IN-HOME-NEW-PATIENT-EVALUATION-MANAGEMENT-HIGH-COMPLEXITY

HCPCS G9982: Remote In-Home New Patient Evaluation and Management

HCPCS-G8506-ACE-INHIBITOR-ARB-THERAPY-DOCUMENTATION

HCPCS G8506: Patient Receiving ACE Inhibitor or ARB Therapy

HCPCS-G6023-FLEXIBLE-SIGMOIDOSCOPY-STENT-PLACEMENT

HCPCS G6023: Flexible Sigmoidoscopy with Transendoscopic Stent Placement

HCPCS-G0554-DIGITAL-MENTAL-HEALTH-TREATMENT-MANAGEMENT

HCPCS G0554: Digital Mental Health Treatment Management, 20-Minute Increments

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207RH0000X`	Infectious Disease	Infectious disease specialists commonly order and interpret HCV genotype testing and manage antiviral therapy.
`207RH0000X`	Hepatology (subspecialty within gastroenterology)	Hepatologists or gastroenterologists manage chronic HCV and select treatment based on genotype.
`208000000X`	Gastroenterology	General gastroenterologists frequently evaluate HCV patients, order genotype testing, and coordinate treatment.
`208000000X`	Internal Medicine	Primary care internists often initiate HCV screening and coordinate diagnostic testing prior to specialist referral.
`363L00000X`	Laboratory Director	Clinical laboratory professionals and directors oversee testing quality and reporting for genotype assays.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`B18.2`	Chronic viral hepatitis C	Primary diagnosis indicating chronic HCV infection; indicates need for genotype testing prior to antiviral therapy.
`B19.20`	Unspecified viral hepatitis C without hepatic coma	Used for documented HCV infection when more specific chronicity coding is not recorded; genotype testing guides treatment.
`K75.2`	Nonalcoholic steatohepatitis (NASH)	Coexisting liver disease that may influence treatment considerations and baseline liver status prior to therapy.
`K74.60`	Unspecified cirrhosis of liver	Presence of cirrhosis affects regimen selection and urgency of genotype testing prior to treatment initiation.
`Z79.899`	Other long term (current) drug therapy	May be used when documenting ongoing medications that could interact with HCV antivirals; genotype testing remains necessary.
`R68.89`	Other general symptoms and signs	Non-specific symptom code sometimes present in evaluation visits; genotype testing supports definitive diagnosis for targeted therapy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`87491`	Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, quantification	Performed to quantify HCV RNA prior to therapy; often ordered alongside genotype testing to establish viral load and treatment necessity.
`87902`	Infectious agent genotyping by nucleic acid (e.g., HCV genotype)	Directly relates to genotype identification; may be the specific laboratory method billed for genotype determination.
`82520`	Drug assay, qualitative; hepatitis C virus antibody (HCV)	Used earlier in the diagnostic cascade to identify prior exposure; antibody testing often precedes genotype testing.
`36415`	Collection of venous blood by venipuncture	Specimen collection code used when blood is drawn for HCV genotype and viral load testing.
`99000`	Handling and/or conveyance of specimen for transfer from the office to a laboratory	Applicable for offices that bill specimen handling when sending specimens to external labs.

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