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HCPCS G0009 · Level II · G code

G0009: Administration of pneumococcal vaccine, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for G0009

Medicare payment
$47.84
OPPS rate, SI S
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Facility outpatient MUE
1
MAI 2
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
7
4 hospital outpatient
LCDs and articles
0 / 1

TL;DR

G0009 is a Level II code from the G section (procedures and professional services, temporary), in use since 1994: "Administration of pneumococcal vaccine". Hospital outpatient departments are paid $47.84 for G0009 under status indicator S, APC 5691 (Level 1 Drug Administration), minimum unadjusted copayment $0.00 (October 2026 Addendum B). CMS caps G0009 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. G0009 is a primary code for 3 add-on codes (90472, 90474, 90481). In the NCCI PTP files v323r0 G0009 appears in 3 practitioner pairs as column 2 and 4 as column 1 (most often with 90460, 90471, G0162), and in 3 hospital outpatient pairs as column 2 and 1 as column 1. 1 billing and coding article lists G0009 across 4 states: A54767. HCPCS record: BETOS O1G (immunizations/vaccinations); pricing indicator 54; type of service V (pneumococcal/flu vaccine). Nearby codes: G0008, G0010, G0013, G0017.

G0009 descriptor and code status

The October 2026 HCPCS Level II file describes G0009 as “Administration of pneumococcal vaccine”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes. Although searches often call it the "G0009 CPT code", G0009 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of G0009
FieldValue
Short descriptorAdmin pneumococcal vaccine
Added to HCPCS1994-01-01
Last actionN (no maintenance), effective 1996-01-01
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator54: vaccinations
BETOS categoryO1G: immunizations/vaccinations
Type of serviceV: pneumococcal/flu vaccine

Medicare payment for G0009

Hospital outpatient departments are paid $47.84 for G0009 under status indicator S, APC 5691 (Level 1 Drug Administration), minimum unadjusted copayment $0.00 (October 2026 Addendum B). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator S (Procedure or service, not discounted when multiple), APC 5691 (Level 1 Drug Administration), national unadjusted payment $47.84 with a minimum unadjusted copayment of $0.00.

Medically Unlikely Edits for G0009

CMS caps G0009 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. The facility outpatient MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for G0009 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for G0009 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0009 is the column-2 (bundled) code in 3 active pairs, 100% of which allow a modifier and the column-1 code in 4 (25% modifier-allowed); 83 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: More extensive procedure.

Column-1 codes most often paired with G0009 (practitioner)
Column-1 codePairs
90460 (CPT; descriptor licensed by AMA)1
90471 (CPT; descriptor licensed by AMA)1
G0162 Hhc rn e&m plan svs, 15 min1
Column-2 codes bundled into G0009 (practitioner)
Column-2 codePairs
36591 (CPT; descriptor licensed by AMA)1
36592 (CPT; descriptor licensed by AMA)1
96523 (CPT; descriptor licensed by AMA)1
99211 (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0009 is the column-2 (bundled) code in 3 active pairs, 100% of which allow a modifier and the column-1 code in 1 (100% modifier-allowed); 16 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: More extensive procedure.

Column-1 codes most often paired with G0009 (hospital outpatient)
Column-1 codePairs
90460 (CPT; descriptor licensed by AMA)1
90471 (CPT; descriptor licensed by AMA)1
G0162 Hhc rn e&m plan svs, 15 min1
Column-2 codes bundled into G0009 (hospital outpatient)
Column-2 codePairs
99211 (CPT; descriptor licensed by AMA)1

G0009 is a designated primary code for 3 add-on codes (90472, 90474, 90481).

Pair counts show exposure, not the answer for one claim. Check G0009 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0009

0 active Local Coverage Determinations and 1 billing and coding article list G0009. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing G0009
ArticleTitleContractor(s)Related LCD
A54767Billing and Coding: Medicare Preventive Coverage for Certain VaccinesPalmetto GBA—

Denials to expect on G0009

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists G0009

CARC 151 · N362

units of G0009 exceed the facility outpatient MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0009 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0009 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0009

What does HCPCS code G0009 describe?

"Administration of pneumococcal vaccine" (short descriptor "Admin pneumococcal vaccine"), in the G section (procedures and professional services, temporary). Added 1994-01-01; last action N (no maintenance) effective 1996-01-01.

Is G0009 a CPT code?

It is not. G0009 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT. "G0009 CPT code" searches refer to it.

What does Medicare pay for G0009?

Hospital outpatient departments are paid $47.84 for G0009 under status indicator S, APC 5691 (Level 1 Drug Administration), minimum unadjusted copayment $0.00 (October 2026 Addendum B).

Is G0009 an add-on code?

G0009 is a primary code for 3 add-on codes (90472, 90474, 90481).

How many units of G0009 can be billed per day?

CMS caps G0009 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. For the facility outpatient MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover G0009?

Coverage code C (carrier judgment, so the Medicare contractor decides coverage). 1 billing and coding article lists G0009 across 4 states: A54767.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.