Summary & Overview
HCPCS G9067: Non-Small Cell Lung Cancer, Staging Unknown
HCPCS Level II code G9067 is a specialized oncology reporting code that denotes non-small cell lung cancer with unknown or in-progress staging, intended for use within a Medicare-approved demonstration project. The code enables clinicians and facilities to document disease status when definitive staging is not yet available or not listed, supporting care coordination and program-specific reporting. Nationally, clear reporting for incomplete or pending staging is important for tracking clinical pathways and aligning demonstration-project metrics with patient care.
Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical context, typical sites of service, and how it is positioned within demonstration project reporting. The publication also summarizes payer coverage considerations and common usage scenarios relevant to billing workflows.
This analysis provides benchmarks and policy context where available, highlights administrative implications for oncology service lines, and outlines the clinical scenarios in which G9067 is appropriate. Data not available in the input for specific modifiers, taxonomies, ICD-10 pairings, and related codes is noted elsewhere in the full publication.
Billing Code Overview
HCPCS Level II code G9067 describes a cancer-related staging descriptor limited to non-small cell lung cancer where the extent of disease is unknown, staging is in progress, or staging is not listed. The code is specified for use in a Medicare-approved demonstration project, indicating it supports reporting of disease status during evaluation or when definitive staging has not yet been established.
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Service type: Oncology disease-status reporting and staging documentation
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Typical site of service: Hospital outpatient departments, oncology clinics, and other settings where cancer staging and diagnostic evaluation occur
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with a history of heavy tobacco use undergoes initial workup for a newly identified pulmonary mass. Imaging (CT and PET) suggests a primary lung malignancy; tissue diagnosis is pending. The oncology team documents that the disease status is limited to non-small cell lung cancer (NSCLC) and that the extent of disease is unknown because staging studies are in progress. The patient is enrolled in a Medicare-approved demonstration project tracking disease status for NSCLC and the treating facility bills the demonstration-specific HCPCS Level II code G9067 to indicate disease status reporting: "extent of disease unknown, staging in progress, or not listed." Typical workflow: initial outpatient oncology consultation, ordering of staging studies (contrast CT chest/abdomen, PET-CT, and brain MRI as indicated), coordination with thoracic surgery or interventional radiology for biopsy, pathology confirmation of NSCLC histology/subtype, and documentation of staging status updates in subsequent visits. The service is typically provided in an outpatient oncology clinic or ambulatory cancer center and may be submitted during the initial consult visit or a follow-up while staging is incomplete. Common payors involved in care coordination include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier information |