Summary & Overview
HCPCS G9071: Invasive Female Breast Cancer, ER/PR Positive
HCPCS Level II code G9071 identifies a narrowly defined disease-status category for female invasive breast cancer used in Medicare demonstration projects. It applies to cases where adenocarcinoma predominates, tumors are ER and/or PR positive, and disease is limited to Stage I, Stage IIA–IIB, or T3, N1, M0, with no evidence of progression, recurrence, or metastasis. Nationally, this code matters for standardized reporting in demonstration initiatives and for capturing a specific clinical population in oncology quality and outcomes measurement.
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 definition tied to the code, typical service settings, and what to expect in benchmarking or policy discussions. The publication summarizes where G9071 fits into oncology service lines, highlights implications for documentation and program reporting, and outlines areas where additional payer-specific guidance may be needed.
This summary is intended for clinicians, coding professionals, and policy analysts seeking a clear national perspective on the clinical scope and reporting purpose of HCPCS Level II code G9071.
Billing Code Overview
HCPCS Level II code G9071 describes a specific oncology disease-status classification for female invasive breast cancer. The code applies when adenocarcinoma is the predominant cell type; disease stage is either Stage I, Stage IIA–IIB, or T3, N1, M0; tumors are ER and/or PR positive; and there is no evidence of disease progression, recurrence, or metastases. The description notes that this coding is intended for use in a Medicare-approved demonstration project.
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Service type: Oncology disease status assessment and classification for specified early-stage, hormone receptor–positive invasive breast cancer.
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Typical site of service: Oncology clinic or hospital outpatient setting where disease-status classification, follow-up assessments, or documentation for demonstration-project reporting are performed.
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Clinical & Coding Specifications
Clinical Context
A 58-year-old woman with a history of invasive female breast adenocarcinoma presents for follow-up evaluation as part of a Medicare-approved demonstration project. Her initial tumor was estrogen receptor (ER) and/or progesterone receptor (PR) positive, stage IIA at diagnosis (T1–T3, N0–N1, M0 as applicable), underwent definitive local therapy (lumpectomy or mastectomy) with axillary staging and adjuvant systemic therapy, and currently has no evidence of disease progression, recurrence, or distant metastases. The clinical workflow includes review of recent pathology and operative reports, interval imaging review (mammography, ultrasound, or breast MRI as indicated), physical breast and regional lymph node exam, review of tumor markers if used, documentation of endocrine therapy adherence and side effects, assessment for lymphedema or post-surgical complications, and coordination of survivorship care planning. The visit is conducted in an outpatient oncology clinic or hospital-based cancer center with nursing support and may involve medical oncology, surgical oncology, or a multidisciplinary survivorship team depending on findings.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard claim with no special circumstances |
22 |