G8631Clinician documented that patient was not an eligible candidate for ordering prophylactic parenteral antibiotics to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)

Long descriptor

Clinician documented that patient was not an eligible candidate for ordering prophylactic parenteral antibiotics to be given within one hour (if fluoroquinolone or vancomycin, two hours) prior to surgical incision (or start of procedure when no incision is required)

Short descriptor

Pt no elg 4 order antbi give

Code family

G — Procedures and professional services (temporary)

Status

Terminated Dec 31, 2014

Added to HCPCS

Jan 1, 2011

Action effective date

Jan 1, 2015

Termination date

Dec 31, 2014

Medicare coverage code

C — Carrier judgment

Pricing indicator

00 — Not separately priced by Part B

NOC list

Not on the CMS NOC list

Maximum units per day (CMS Medically Unlikely Edits)

No published MUE for G8631. CMS keeps some MUE values confidential, so this does not mean there is no daily unit limit.

Quarterly history

No authoritative public data was located for this field.

No CMS NDC–HCPCS crosswalk rows were located. CMS notes its crosswalks are not a comprehensive list of all NDCs.

Drugs whose NDCs CMS crosswalks to G8631

No authoritative public data was located for this field.

• Coverage documents for G8631 NCDs, LCDs, and Billing & Coding articles in the CMS Medicare Coverage Database that mention “G8631”. Covered diagnosis codes are listed in the articles.
• Self-administered drug (SAD) exclusion lists Drugs each MAC excludes from “incident to” Part B coverage because they are usually self-administered.
• Find your Medicare contractor (MAC) A/B and DME MAC jurisdictions by state — local coverage and prior-authorization rules come from your MAC.
• CMS discarded drug (JW/JZ) guidance When the JW and JZ modifiers are required for drugs from single-dose containers.
• NCCI Medically Unlikely Edits CMS MUE tables and quarterly changes for practitioner, outpatient hospital, and DME claims.

Verification neededCodeRx links to coverage documents instead of copying them: CMS distributes their code lists under AMA, ADA, and AHA license terms that limit reuse. Medicare Advantage, Medicaid, and commercial plans set their own coverage and prior-authorization rules.

All imported releases, checksums, and import reports are listed on the data sources page.

• A HCPCS code being valid does not mean Medicare or any other payer covers the item; coverage is determined by the payer and the MAC.
• CMS publishes NDC–HCPCS crosswalks to support ASP-based Part B payment; they are not a comprehensive list of NDCs that may be billed with this code.
• Payment limits are national Medicare Part B limits per billing unit, before deductible, coinsurance, and sequestration. They are not commercial payer rates.
• Hospital outpatient (OPPS) payment rates and status indicators are not included in this release.
• MUE values are the published CMS NCCI limits for Medicare fee-for-service claims; other payers may apply their own unit limits, and CMS keeps some MUE values confidential.