Summary & Overview
HCPCS G9066: Non-Small Cell Lung Cancer, Advanced Disease Status
HCPCS Level II code G9066 designates a disease-status descriptor for non-small cell lung cancer (NSCLC) limited to patients who are stage III B–IV at diagnosis, metastatic, locally recurrent, or progressive, used within a Medicare-approved demonstration project. Nationally, the code matters because it standardizes reporting of advanced NSCLC status in demonstration settings, supporting consistent data capture for care coordination, outcome tracking, and payment models tied to demonstration objectives. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn the clinical context of the code, the typical service setting where it is reported, and how it is used for disease-status documentation in demonstration projects. The publication covers benchmark top-line considerations, relevant policy context for Medicare demonstration use, and operational implications for oncology practices and hospital outpatient clinics. Data not available in the input will be noted where applicable. This summary provides a concise reference for clinicians, administrators, and payers involved in advanced NSCLC care and demonstration program reporting.
Billing Code Overview
HCPCS Level II code G9066 describes an oncology disease-status classification limited to non-small cell lung cancer that is stage III B–IV at diagnosis, metastatic, locally recurrent, or progressive. The code is intended for reporting disease status in the context of a Medicare-approved demonstration project.
Service Type: Oncology disease-status reporting / clinical staging assessment
Typical Site of Service: Hospital outpatient clinics, oncology practices, or other ambulatory oncology sites participating in Medicare demonstration projects
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a history of tobacco use presents after imaging shows a pulmonary mass and mediastinal lymphadenopathy. Biopsy confirms non-small cell lung cancer (NSCLC). At diagnosis the cancer is staged as IIIb and subsequently progresses to stage IV with distant metastases to bone and contralateral lung. The patient is enrolled in a Medicare-approved demonstration project tracking disease status for advanced NSCLC; services billed under G9066 document disease status (metastatic, locally recurrent, or progressive) limited to non-small cell lung cancer stage IIIb–IV at diagnosis.
Clinical workflow: Initial oncology evaluation includes staging CT of chest/abdomen and PET-CT as indicated, pathologic confirmation by thoracic surgery or interventional pulmonology, molecular testing on tumor tissue, and multidisciplinary tumor board review. Disease-status assessments occur at intervals (baseline, during systemic therapy, at progression) and include clinical evaluation, radiology reports, and documentation in the oncologist’s encounter for submission of G9066 to the Medicare demonstration project. Typical sites of service include hospital outpatient departments, oncology clinics, and tertiary cancer centers where multidisciplinary care and clinical tracking for demonstration projects are coordinated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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