HCPCS

# What is A9270 HCPCS code? What Are Its Uses

- February 27, 2025
- Posted by Brian Bertrand

27 Feb

Medical billing is a game. If you place the wrong codes, the incorrect claims will be submitted, and sometimes, the payments can take months to arrive, or the bills stay unpaid. Specifically, A9270 is one of the HCPCS codes for which the definition is perhaps the most frequently misinterpreted by healthcare service providers today.

This code, A9270 HCPCS code, is an unbundling code that is billable for non-covered services, and it results in denials and patient self-pay charges for consumers. The A9270 HCPCS code and its payment rules, Medicare, fee schedules, the application of the A9270 GY CPT Code modifier and how it is related to denial codes such as B73. Let me effectively explain the meaning of A9270 code in details along with anything related to it.

## Understanding A9270 HCPCS Code

### A9270 HCPCS Code

The HCPCS code A9270 has the description as “Non-covered item or service”. It is used when an item or service is not directly identifiable with an HCPCS code or is not reviewed by Medicare or other private insurers.

### Common Uses of A9270

Providers typically use A9270 when:

- Billing for all the other services not covered by the health insurance and other personal amenities like toiletries.
- Covering for the treatment that insurance companies have not recognized as a valid expending yet or supplies, which may include, for instance, experimental treatments.
- Takeover of self-medication products that are relatively taken without the prescription or supervision of a medical practitioner.

A9270 is actually only a code that informs, “This service or item is not a part of the applicable reimbursable policies.”

## A9270 HCPCS Code Reimbursement

The Medicare or the other third-party payers cannot reimburse A9270 in many cases. Medicare will automatically reject any claim the has A9270. However, there are certain cases when the private insurance plans might provide coverage, albeit this is not very common. Currently, it is the patient’s cost liability that ranges several services associated with A9270.

## How to Handle A9270 Denials

A9270 HCPCS code reimbursement is complex; the following tasks have to be accomplished:

- Advise patients prior to the treatment (ABN-Advance Beneficiary Notice)
- For claim processing, it is advisable to use such modifiers like GY.
- It is useful to check if there are other HCPCS codes that would allow for a better reimbursement to be obtained.

## A9270 GY CPT Code Modifier

The GY modifier is used with the A9270 code, where a provider is aware that a particular service is not payable under the insurance but requires authority to issue a denial.

- GY A9270 CPT Code instructs Medicare: “This is not allowed – do not pay for it.”
- This one enables the providers to bill the patient directly when the denial is official.
- Regarding drugs used for self-administered drugs and any DME’s other non-reimbursable items.

### Example of A9270 with GY Modifier

If a beneficiary buys an over-the-counter medical device that is not on the list of products that are eligible for Medicare coverage, the claim appears as follows:

A9270-GY → Non-covered item (denial expected, patient, billed directly).

## A9270 HCPCS Code Medicare

Medicare does not recognize A9270 as a service that they would be willing to reimburse. The main reasons include:

It is not considered as essential medical care. In most cases, it is considered a non-Medicare service, which includes luxury or experimental services. It is not within the eligibility for programs funded by Medicare as it does not fall within any of the scheme classifications.

What Does This Mean for Billing?

- It is important to note that if you encode A9270 on the claim, Medicare should automatically deny the claim.
- Always provide an ABN so that the patient is informed that the charges will be on him or her.

### A9270 Fee Schedule

A9270 is an uncoded service; there are no fee schedule codes in Medicare following this service.

## How to Set Pricing for A9270?

There are several key cost factors that providers decide from which they give the price:

- Pricing – This includes the price commonly seen by the external world in regard to the specific commodity or the services that the company offers.
- Private insurance contracts (if applicable).
- Patient agreement to out-of-pocket charges.

## A9270 Apply to Self-Administered Drugs

Medicare Part B only covers medications administered by a healthcare professional. If a drug is self-administered, it falls under A9270 and is NOT covered.

### Examples of A9270 self-administered drugs

- Insulin injections for diabetic patients.
- Over-the-counter pain relief medications.
- Devices such as nebulizers that were used outside the supervision of qualified health care personnel.

These do not necessitate charging from a professional account, and thus, A9270 is billed directly to the patient for all the reimbursable services they have incurred.

## A9273 CPT Code

A9273 CPT Code relates only to diabetic products sold over-counters, including glucose meters, test strips, etc. While A9270 is much more general and pertains to any non-covered supply, A9273 specifically designates diabetic monitoring products, which are non-covered and non-reimbursable by Medicare if bought by the patient over the counter. This code is specifically used to properly bill for other miscellaneous diabetic supplies that are not reimbursable by regular medical insurance.

## B73 Denial Code

The B73 denial code reveals that the services provided or the item are non-reimbursable by Medicare and is usually brought about by the use of an A9270 code. To address this denial, the providers should append the GY modifier on the claims, check for the other codes, and make sure to give the ABN to the patients beforehand. This minimizes billing disputes and is necessary for better understanding by the patient.

## Best Practices for Using A9270 in Medical Billing

- A9270 must be used only when there is no other HCPCS code that can be applicable.
- Appending GY modifier should be used when Medicare denial is anticipated.
- Ensure patients sign an ABN form to the cost they are exposed to in their treatment.
- In some cases, variants of standard codes, such as A9273, should be used.

## Conclusion

The A9270 HCPCS code is an A/B Non-Medically Unlikely code, which means that it is a code assigned to an item or service, which is not considered to be reimbursable by Medicare or insurance. Learning about how A9270 HCPCS code reimbursement, when to use A9270/GY CPT code, and a definition of B73 denial codes can be valuable time savers.

## FAQs

### 1. What is the HCPCS Level II code for a bathtub chair?

The code for a bathtub chair is E0240, as this equipment lies under the HCPCS Level 2 Code.

### 2. What is the HCPCS code A9277?

The A9277 HCPCS code can be used for transcutaneous electrical nerve stimulator supplies.

### 3. What is the HCPCS code for a humidifier?

HCPCS code for a humidifier is E0561 if it is not heated, and it is E0562 in case it is heated.

### 4. What is the difference between HCPCS Level 1 and Level 2 codes?

HCPCS Level 1 code is the CPT code, which deals with medical services and procedures, while the HCOCS Level 2 code deals with physician’s services and includes equipment and materials, and other drugs. You can also read the through differences between these here.

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