Summary & Overview
HCPCS G9247: HIV Care Engagement Over 90-Day Interval
HCPCS Level II code G9247 documents patient engagement in HIV care by capturing either two eligible clinical encounters at least 90 days apart or one eligible encounter plus one HIV viral load test at least 90 days apart. Nationally, this measure is important because it signals sustained linkage to HIV monitoring and care, a key element in prevention of transmission and long-term management. Payers use codes like G9247 to track continuity of care, quality metrics, and eligible service delivery across outpatient settings.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical intent, typical service settings, and the role of the code in longitudinal HIV care measurement. The publication also outlines common modifiers, coverage context, and gaps where input data were not provided.
This summary equips clinicians, billing professionals, and policy analysts with the essential context for HCPCS Level II code G9247, describing what it represents, why it matters nationally for HIV care continuity monitoring, and what elements to expect in payer policy and claims reporting. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G9247 indicates that a patient had two eligible encounters at least 90 days apart or one eligible encounter and one HIV viral load test at least 90 days apart. This code documents longitudinal engagement in HIV-related care over a minimum 90-day interval.
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Service type: Longitudinal HIV care engagement tracking
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Typical site of service: Outpatient clinic or ambulatory care settings where HIV monitoring and follow-up occur, including HIV specialty clinics and primary care settings that provide ongoing HIV care
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient living with HIV presents for routine HIV care. The measure for billing code G9247 indicates the patient must have two eligible encounters at least 90 days apart, or one eligible encounter and one HIV viral load test at least 90 days apart. A typical clinical workflow: initial visit (comprehensive HIV management visit) documents history, antiretroviral therapy (ART) adherence, and orders baseline or routine laboratories including HIV viral load. The patient returns for a follow-up visit at least 90 days later for adherence counseling and assessment of symptoms, or has a documented HIV viral load test performed at least 90 days after the first encounter. Visits occur in outpatient primary care, HIV specialty clinics, community health centers, or telehealth visits. Typical sites of service include outpatient clinic examination rooms, hospital-based outpatient clinics, federally qualified health centers, and telemedicine platforms. The scenario often involves ongoing chronic disease management, medication reconciliation, laboratory monitoring, and counseling about prevention and comorbidity screening. Documentation must show encounter dates separated by ≥90 days or one encounter plus an HIV viral load test date ≥90 days apart to justify G9247 reporting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |