HCPCS G9065: Non-Small Cell Lung Cancer Disease Status, Stage IIIA - OpenPayer

Summary & Overview

HCPCS G9065: Non-Small Cell Lung Cancer Disease Status, Stage IIIA

HCPCS Level II code G9065 designates a documented disease status for non-small cell lung cancer (NSCLC) originally staged as III A with no evidence of progression, recurrence, or metastases prior to any neo-adjuvant therapy. The code is specific to use within a Medicare-approved demonstration project and captures a clinical staging snapshot important for program eligibility, research, and outcomes tracking. Nationally, standardized staging documentation supports consistent patient selection for demonstrations and can inform broader quality and outcomes efforts in oncology.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical meaning and service context, an outline of typical sites of service, and guidance on where this code fits within oncology documentation and demonstration projects. The publication also summarizes policy considerations relevant to Medicare demonstration use and highlights which types of clinical workflows and reporting initiatives commonly rely on this staged disease-status designation. Data not available in the input is clearly noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9065HCPCS Level IInon-small cell lung canceroncologydisease statusstagingstage IIIAmedicare demonstration

Billing Code Overview

HCPCS Level II code G9065 describes a disease-status designation for non-small cell lung cancer. The code indicates that the extent of disease was initially established as stage III A (prior to any neo-adjuvant therapy) with no evidence of disease progression, recurrence, or metastases, and is intended for use in a Medicare-approved demonstration project.

Service type: Oncology — disease status assessment / documentation

Typical site of service: Hospital outpatient oncology clinic or cancer center, including settings where patients are clinically staged and documented for demonstration or registry purposes.

Clinical & Coding Specifications

Clinical Context

A 64-year-old patient with a prior histologic diagnosis of non-small cell lung cancer (NSCLC) initially staged as stage IIIA before any neoadjuvant therapy presents for enrollment and follow-up within a Medicare-approved demonstration project that tracks disease status. The patient completed neoadjuvant chemotherapy and/or radiotherapy without evidence of progression, recurrence, or distant metastases on recent imaging and clinical assessment. The clinical workflow includes: initial documentation of the baseline extent of disease as stage IIIA (pre‑neoadjuvant), multidisciplinary tumor board confirmation of stage and treatment plan, periodic surveillance visits with chest CT and/or PET as indicated, oncology clinic notes documenting stability/no evidence of disease, and submission of the HCPCS Level II code G9065 to report disease status limited to NSCLC with the described staging and stability for demonstration project reporting. Typical clinicians involved include medical oncologists, thoracic surgeons, radiation oncologists, and oncology-certified nurse practitioners or physician assistants. Typical administrative steps include verifying Medicare demonstration eligibility, capturing contemporaneous clinical documentation stating initial stage IIIA and current lack of progression/recurrence/metastases, and appending appropriate claim modifiers as required by the payer and project protocols.

Coding Specifications

Modifier	Description	When to Use

HCPCS G0061: Anesthesiology MIPS Specialty Set

HCPCS-G9937-DIAGNOSTIC-COLONOSCOPY

HCPCS G9937: Diagnostic Colonoscopy

HCPCS-G4032-RHEUMATOLOGY-MIPS-SPECIALTY-SET

HCPCS G4032: Rheumatology MIPS Specialty Set

HCPCS-G9800-BETA-BLOCKER-INTOLERANCE-ALLERGY

HCPCS G9800: Beta-Blocker Intolerance or Allergy

HCPCS-G0219-PET-WHOLE-BODY-MELANOMA-NON-COVERED-INDICATIONS

HCPCS G0219: PET Whole-Body Imaging for Melanoma (Non-Covered Indications)

HCPCS-G0560-SAFETY-PLANNING-INTERVENTION-20-MIN

HCPCS G0560: Safety Planning Intervention, 20-Minute Units

HCPCS-G9879-MDPP-CORE-MAINTENANCE-TWO-SESSIONS-5-PERCENT-WEIGHT-LOSS

HCPCS G9879: MDPP Core Maintenance Two Sessions with 5% Weight Loss

HCPCS-G9656-PATIENT-TRANSFER-ANESTHETIZING-LOCATION-TO-PACU-NONICU

HCPCS G9656: Patient Transfer from Anesthetizing Location to PACU or Non-ICU

HCPCS-G9774-POST-HYSTERECTOMY-PATIENT-STATUS

HCPCS G9774: Patient Status, Post-Hysterectomy

HCPCS-G9804-BETA-BLOCKER-POST-AMI-TREATMENT-GAP

HCPCS G9804: Post-AMI Beta-Blocker Treatment Gap

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`00`	No modifier (standard)	Use when no special circumstances apply to the claim for `G9065`.
`22`	Increased procedural services	Use when the encounter required substantially greater work than typical, documented in the record.
`23`	Unusual anesthesia	Use if general anesthesia was unexpectedly required for a procedure performed in the same encounter that supports reporting activity tied to disease-status assessment.
`52`	Reduced services	Use when the service was partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when a planned diagnostic or therapeutic procedure related to staging/surveillance was started but terminated for patient safety.
`54`	Surgical care only	Use if only the surgical component was provided by the billing practitioner and other services billed separately.
`55`	Postoperative management only	Use if only postoperative management was billed by the reporting practitioner in the same global period.
`56`	Preoperative management only	Use if only preoperative management was billed by the reporting practitioner in the same global period.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons on a complex thoracic resection relevant to initial staging or management.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an APP served as surgical assistant during a thoracic procedure related to initial staging or management.
`CO`	Services related to approved demonstration project	Use to indicate services furnished as part of a Medicare-approved demonstration project when payer requires explicit identification.
`CQ`	Service furnished under a research protocol, clinical trial	Use when the disease-status assessment is part of an approved clinical trial or research protocol.
`QK`	Personal factor services by CRNA	Use when a Certified Registered Nurse Anesthetist provided anesthesia services requiring distinct reporting.
`QX`	CRNA service with medical direction by physician	Use when CRNA services were furnished with physician medical direction.

Taxonomy Code	Specialty	Notes
`207RE0100X`	Medical Oncology	Primary clinicians responsible for systemic therapy and disease-status assessment.
`2084P0800X`	Thoracic Surgery	Surgeons performing diagnostic staging procedures and resections tied to initial staging.
`2084N0400X`	Radiation Oncology	Providers overseeing neoadjuvant or adjuvant radiotherapy and imaging surveillance.
`363L00000X`	Nurse Practitioner	Oncology NPs frequently document clinic disease‑status assessments and follow-up.
`364S00000X`	Physician Assistant	PAs assist in perioperative and clinic care documenting disease status.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.10`	Malignant neoplasm of upper lobe, right bronchus or lung	Common primary site code for NSCLC; relevant when documenting disease site for staging `IIIA`.
`C34.11`	Malignant neoplasm of upper lobe, left bronchus or lung	As above for left-sided lesions; used to specify primary tumor location when reporting disease status.
`C34.92`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Used when a more specific lung site is not documented but NSCLC disease status is reported.
`C78.00`	Secondary malignant neoplasm of unspecified lung	Included to document metastatic lung involvement when assessing for absence of metastases; relevant to exclude when reporting `G9065`.
`Z85.118`	Personal history of malignant neoplasm of bronchus and lung	Relevant in surveillance patients with prior lung cancer where disease-status reporting documents no recurrence or progression.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31625`	Bronchoscopy, rigid or flexible, diagnostic, with or without cell washing; with biopsy, single or multiple	Diagnostic bronchoscopic biopsy used at initial diagnosis or to re-biopsy suspicious lesions during surveillance.
`32480`	Thoracoscopy, surgical; with diagnostic biopsy(s) of lung lesion(s) (including pleural biopsies), with or without pleurodesis	Minimally invasive thoracoscopic procedures used for tissue diagnosis or staging relevant to initial `IIIA` assessment.
`32925`	Thoracotomy for pulmonary resection or lobectomy; single lobe	Surgical resection performed as part of definitive management following initial `IIIA` staging; related operative documentation may be referenced when reporting disease status.
`71260`	Computed tomography, thorax; with contrast material(s)	Cross-sectional imaging commonly used for staging and surveillance to document no evidence of progression or metastasis.
`78816`	Positron emission tomography (PET) with concurrently acquired CT for attenuation correction and anatomic localization, whole body	PET/CT used to assess metabolic activity and exclude metastatic disease during staging and follow-up.

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