Summary & Overview
HCPCS G9542: Re-assessment of Filter Removal Appropriateness within 3 Months
HCPCS Level II code G9542 documents a documented re-assessment of the appropriateness of filter removal within three months of placement. The code applies to clinicians performing follow-up evaluations to determine whether a vascular filter remains indicated or should be retrieved during the early post-placement period. Nationally, timely reassessment affects patient safety, procedural planning, and use of retrieval resources.
Key payers addressed in this summary include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical intent and common sites of service, plus context on why timely reassessment matters for quality of care and downstream utilization. The publication provides benchmarks where available, notes on payer coverage patterns, and highlights relevant policy considerations affecting documentation and coding for early filter reassessment.
This piece is written for a national audience and aims to clarify code purpose, expected clinical workflow, and what to expect in payer interactions when billing for an early post-placement reassessment of filter removal appropriateness. Data not available in the input is identified where applicable.
Billing Code Overview
HCPCS Level II code G9542 documents a re-assessment for the appropriateness of filter removal within 3 months of placement. This code represents a clinical follow-up evaluation specifically focused on determining whether a previously placed vascular filter (such as an inferior vena cava filter) remains indicated and whether removal is appropriate within the early post-placement window.
Service type: Clinical reassessment / follow-up evaluation
Typical site of service: Outpatient clinic or hospital outpatient setting where vascular or interventional follow-up visits occur
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 55–75-year-old who had a temporary inferior vena cava (IVC) filter placed for acute venous thromboembolism (deep vein thrombosis or pulmonary embolism) when anticoagulation was contraindicated or ineffective. Within 3 months of placement the implanting physician or vascular specialist performs and documents a re-assessment visit to determine continued appropriateness of filter retention versus planned retrieval. The clinical workflow includes review of the original indication, interval change in clinical status, current anticoagulation eligibility, imaging review (venous duplex or CT venography to assess filter position and clot burden), evaluation for device-related complications (migration, tilt, penetration, fracture), shared decision-making documentation, and scheduling of retrieval if indicated. Typical sites of service are outpatient vascular clinic, physician office, hospital outpatient department, or interventional radiology clinic. Typical patient scenario: patient placed a retrievable IVC filter after major trauma with contraindication to anticoagulation; at a 6–8 week follow-up the specialist documents reassessment of filter removal appropriateness, documents findings and plan, and either schedules percutaneous retrieval or documents rationale for continued filter retention and plans for re-evaluation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When work required is substantially greater than typical and documented (e.g., complex decision-making for filter retention with extensive imaging review). |