Summary & Overview
HCPCS G9052: Oncology Surveillance Visit After Definitive Therapy
HCPCS Level II code G9052 denotes an oncology follow-up visit centered on surveillance for disease recurrence in patients who have completed definitive cancer-directed therapy and currently lack evidence of recurrent disease. The code is notable for its use in a Medicare-approved demonstration project and clarifies a visit type distinct from active cancer treatment. Nationally, clear coding for survivorship and surveillance visits affects continuity of care, tracking of outcomes, and alignment of reimbursement pathways for post-treatment oncology services.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for G9052, how the service is typically delivered in outpatient or office oncology settings, and what this code represents for post-treatment surveillance. The publication also highlights common modifiers and the demonstration-project context associated with G9052.
This resource provides: (1) a clinical description and service context for the code; (2) payer coverage framing; and (3) practical metadata for coding and billing workflows. Data not available in the input is noted where applicable; the focus remains on national-level interpretation and operational implications of using HCPCS Level II code G9052 for oncology surveillance visits.
Billing Code Overview
HCPCS Level II code G9052 describes an oncology visit with a primary focus on surveillance for disease recurrence in a patient who has completed definitive cancer-directed therapy and currently shows no evidence of recurrent disease. The description specifies that cancer-directed therapy might be considered in the future and that this code is intended for use in a Medicare-approved demonstration project.
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Service type: Oncology surveillance visit focused on post-treatment disease monitoring
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Typical site of service: Office-based or outpatient oncology clinic visit focused on follow-up and survivorship care
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult who completed definitive cancer-directed therapy (for example, surgery with curative intent and/or adjuvant chemotherapy and/or radiotherapy) and currently has no clinical, radiographic, or laboratory evidence of recurrent disease. The patient presents for a scheduled oncology surveillance visit focused on detection of recurrence and monitoring for late effects of prior therapy. The visit may include interval history, focused physical examination, review of prior treatment summary, ordering and review of surveillance imaging or laboratory tests (for example tumor markers), counseling about signs and symptoms of recurrence, and planning of next surveillance interval. The clinician documents that cancer-directed therapy is not currently being administered and that the primary focus is surveillance; discussion may include consideration that cancer-directed therapy might be needed in the future if recurrence is detected. Typical clinical workflow: pre-visit record review by nursing to confirm prior cancer-directed therapy completion; intake vitals and symptom screening; face-to-face (or approved telehealth in demonstration contexts) encounter with an oncologist, advanced practice provider, or survivorship clinic clinician; ordering of indicated surveillance tests; documentation of surveillance plan and survivorship counseling; billing under G9052 for the surveillance-focused oncology visit as part of the Medicare-approved demonstration project if applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |