Summary & Overview
HCPCS G9214: CD4+ Cell Count or Percentage Results Documented
HCPCS Level II code G9214 indicates documentation of CD4+ cell count or CD4+ cell percentage results in the medical record. This designation captures a clinical documentation event tied to laboratory monitoring of immune status, most commonly used in the care of patients with immunodeficiency or conditions requiring CD4 surveillance. Nationally, consistent documentation of CD4 results supports clinical decision-making, quality reporting, and appropriate claims adjudication across payers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the code, typical sites of service, and what the code represents in claims workflows. The publication outlines benchmarks for documentation usage where available, summarizes relevant policy updates that affect billing and coverage, and highlights associated clinical considerations for accurate coding and recordkeeping. The content is tailored for a national audience and is intended to help coding professionals, billing managers, and clinical staff understand the purpose of G9214, how it fits into laboratory reporting and monitoring, and where to look for payer-specific guidance.
Billing Code Overview
HCPCS Level II code G9214 documents CD4+ cell count or CD4+ cell percentage results when those results are recorded in the medical record. The service type is laboratory result documentation reflecting immunologic monitoring for patients with conditions that affect CD4+ lymphocyte levels. Typical site of service for this code is outpatient clinic or laboratory setting, where blood testing and result review are performed.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult living with HIV who presents for routine follow-up in an outpatient infectious disease clinic or community health center. The clinician orders a laboratory panel that includes a CD4+ T-lymphocyte count and/or CD4+ percentage to monitor immune status and inform antiretroviral therapy effectiveness, opportunistic infection risk assessment, and prophylaxis decisions. Venipuncture is performed by phlebotomy staff in the clinic or at an external laboratory; the specimen is sent to a certified flow cytometry laboratory. Results are documented in the electronic health record as either an absolute CD4+ cell count (cells/µL) or CD4+ percentage of total lymphocytes, with interpretation notes and comparison to prior values. The documented result triggers clinical actions such as continuation or modification of antiretroviral therapy, initiation or discontinuation of prophylactic medications, or scheduling of closer follow-up and additional testing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation of a laboratory result when allowed by payer rules. |