Summary & Overview
HCPCS G9064: Non-Small Cell Lung Cancer Disease Status, Stage II
HCPCS Level II code G9064 denotes a documented disease status for non-small cell lung cancer (NSCLC) where the initial extent was established as stage II and there is no evidence of progression, recurrence, or metastases. It is specified for use within a Medicare-approved demonstration project and serves as a standardized way to record favorable disease status after initial staging, prior to any neo-adjuvant therapy. Nationally, clear coding for disease status supports clinical tracking, coverage determinations in demonstration contexts, and consistent data for program evaluation.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on the clinical context and service setting for G9064, plus discussion of payer coverage considerations and benchmarking approaches. The publication outlines expected use cases, typical sites of service, and how this code fits into oncology documentation workflows. Where input-specific data are not provided, the report notes that those fields are not available in the input. The focus is national in scope, addressing how G9064 functions within demonstration project reporting and broader oncology billing practices.
Billing Code Overview
HCPCS Level II code G9064 documents disease status for non-small cell lung cancer when the extent of disease was initially established as stage II (prior to any neo-adjuvant therapy) with no evidence of disease progression, recurrence, or metastases. This code is designated for use in a Medicare-approved demonstration project.
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Service type: Oncology disease status assessment
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Typical site of service: Oncology clinic or hospital-based oncology service where staging and disease-status evaluations are performed
Clinical & Coding Specifications
Clinical Context
A 64-year-old patient with a recent diagnosis of non-small cell lung cancer (NSCLC) confined to the lung undergoes staging and enrollment in a Medicare-approved demonstration project to track disease status. Initial workup established clinical stage II disease prior to any neoadjuvant therapy. The patient presents to a multidisciplinary thoracic oncology clinic for baseline disease-status documentation. The workflow includes review of prior imaging (CT chest with contrast, PET-CT), pathology confirming NSCLC subtype, and documentation that there is no evidence of progression, recurrence, or metastatic spread since initial staging. The attending thoracic oncologist records the disease status specifically limited to NSCLC stage II, confirms absence of new lesions on recent imaging, and submits the oncology-specific HCPCS Level II code G9064 as part of demonstration project reporting. Typical visits occur in an outpatient oncology clinic or hospital-based outpatient department, often coordinated with radiation oncology and thoracic surgery consultations, and may be timed before neoadjuvant therapy, surgical intervention, or initiation of systemic therapy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no specific modifier applies and service is billed normally |