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See a sample rate comparisonHCPCS G9505 Fee Schedule
HCPCS G9505 is classified under Procedures / Professional Services, in the Additional Assorted Quality Measures subgroup.
Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Additional Assorted Quality Measures |
National average reimbursement for HCPCS G9505 by major payers:
$69.94
BCBS / Anthem
$N/A
UnitedHealthcare
$0.01
Aetna
$1.16
Cigna
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HCPCS G9505
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Payer Contract Negotiation
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See a sample payer proposalHCPCS G9505 vs. Other Additional Assorted Quality Measures Codes
The table lists codes related to G9505. Select one to see its fee schedule.
| Code | Description |
|---|---|
| G9504-HCPCS | Documented reason for not assessing hepatitis B virus (HBV) status (e.g., patient not initiating anti-TNF therapy, patient declined) prior to initiating anti-TNF therapy |
| G9505-HCPCS | Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason |
| G9507-HCPCS | Documentation that the patient is on a statin medication or has documentation of a valid contraindication or exception to statin medications; contraindications/exceptions that can be defined by diagnosis codes include pregnancy during the measurement period, active liver disease, rhabdomyolysis, end stage renal disease on dialysis and heart failure; provider documented contraindications/exceptions include breastfeeding during the measurement period, woman of child-bearing age not actively taking birth control, allergy to statin, drug interaction (hiv protease inhibitors, nefazodone, cyclosporine, gemfibrozil, and danazol) and intolerance (with supporting documentation of trying a statin at least once within the last 5 years or diagnosis codes for myositis or toxic myopathy related to drugs) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G9505. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G9505 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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