Summary & Overview

HCPCS G9073: Invasive Female Breast Cancer Disease Status, Stage IIIA–IIIB

HCPCS Level II code G9073 denotes a specific oncology disease-status classification for invasive female breast cancer: adenocarcinoma predominant, stage IIIA–IIIB (not T3, N1, M0), estrogen and/or progesterone receptor positive, with no evidence of progression, recurrence, or metastases. The code is defined for use within a Medicare-approved demonstration project and is intended to standardize documentation of a patient’s oncologic status rather than represent a discrete treatment or procedure. Nationally, standardized status codes like G9073 support consistent clinical tracking, eligibility criteria for programs, and analytic comparisons across providers and payers.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides readers with benchmarks and context for how this status code fits into oncology billing and reporting, summarizes payer coverage considerations where available, and outlines the clinical context—particularly receptor status and staging—that this code captures. It also highlights implications for outpatient oncology and survivorship workflows, and flags that the code’s primary role is documentation within demonstration or special-project settings. Data not available in the input is noted where applicable, and readers will find concise guidance on the code’s purpose, typical site of service, and the clinical defined population it represents.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9073HCPCS Level IIoncologybreast cancerdisease statusstage IIIER PR positivesurvivorshipdemonstration project

Billing Code Overview

HCPCS Level II code G9073 describes a specific oncology status: invasive female breast cancer (excluding ductal carcinoma in situ), adenocarcinoma predominant, stage IIIA–IIIB (not T3, N1, M0), estrogen and/or progesterone receptor positive, with no evidence of disease progression, recurrence, or metastases. This code is intended for use in a Medicare-approved demonstration project and documents a defined disease status rather than a specific procedure or therapy.

Service Type: Oncology disease status reporting and surveillance

Typical Site of Service: Outpatient oncology clinic or cancer center, including physician office visits focused on disease-status evaluation and survivorship follow-up.

Clinical & Coding Specifications

Clinical Context

A 58-year-old female with a history of invasive adenocarcinoma of the right breast, estrogen receptor positive and/or progesterone receptor positive, initially staged as IIIB (tumor without T3N1M0 pattern and no evidence of ductal carcinoma in situ) presents for longitudinal disease status evaluation as part of a Medicare-approved demonstration project. She completed primary therapy (surgery ± radiation and systemic endocrine therapy) and currently has no clinical, radiographic, or pathologic evidence of disease progression, recurrence, or distant metastasis. The clinical workflow includes a multidisciplinary visit with a medical oncologist or breast surgeon to document disease status, review recent imaging (mammography, breast MRI, chest imaging), review pathology and tumor markers, document hormone receptor status and staging details, and confirm ongoing surveillance or maintenance endocrine therapy.

Typical site of service is an outpatient oncology clinic or hospital outpatient department where documentation of disease status for demonstration reporting and reimbursement occurs. The encounter involves history review, physical examination focused on local and regional findings, synthesis of imaging and pathology results, and formal documentation that the patient meets the specific inclusion criteria described by the billing code for the demonstration project.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier	When no special modifier applies to the service.
`22`	Increased procedural services	If the encounter required substantially greater work than typical documentation/assessment for disease status (rare for status reporting).
`23`	Unusual anesthesia	Not commonly applicable; use only if anesthesia was unexpectedly required for related procedures during the visit.
`52`	Reduced services	When a planned component of the evaluation was partially reduced or not completed.
`53`	Discontinued procedure	If an intended procedure or assessment for disease status was started but terminated for patient safety.
`54`	Surgical care only	If reporting only the surgical portion of an encounter separate from pre/postoperative management (applies to surgeons involved in initial therapy, not typical for this status code).
`55`	Post-operative management only	When only post-operative follow-up is billed by the surgeon and pre/postoperative global period rules apply.
`56`	Pre-operative management only	If only the preoperative management portion was performed and reported separately.
`62`	Two surgeons	When two surgeons of different specialties share responsibility for a single operative service related to the patient’s cancer care (unlikely for status reporting but included for surgical contexts).
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an advanced practice provider served as surgical assistant in a related operative procedure.
`CO`	Occupational therapy	If occupational therapy services are separately provided and billed in conjunction with the oncology visit.
`CQ`	Service furnished by a clinical psychologist	Use when a clinical psychologist provided a billable component during the same encounter (psychosocial assessment related to diagnosis).
`FX`	Synthetic modifier (facility-specific)	Use only where applicable per payer instructions for facility-related reporting.
`QX`	CRNA service with medically directed anesthesia	If a certified registered nurse anesthetist provided anesthesia services during a related procedure.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Medical Oncology	Primary specialty for ongoing disease-status assessment and management of invasive breast cancer.
`207XS0112X`	Hematology/Oncology	Specialists who manage systemic therapy and long-term surveillance.
`207L00000X`	Surgical Oncology	Surgeons managing operative treatment and postoperative surveillance relevant to staging and status documentation.
`207R00000X`	Radiation Oncology	Radiation oncologists involved in prior or ongoing local therapy; may document effects relevant to disease status.
`363L00000X`	Nurse Practitioner	Advanced practice providers commonly perform surveillance visits and documentation for demonstration projects.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C50.912`	Malignant neoplasm of unspecified site of right female breast	Represents invasive breast cancer relevant to disease status reporting when laterality or exact quadrant is unspecified.
`C50.911`	Malignant neoplasm of central portion of right female breast	Specific invasive breast cancer location that may affect staging and local surveillance.
`C50.119`	Malignant neoplasm of unspecified site of left female breast	Left-sided invasive breast cancer alternative for documentation of disease status.
`C50.212`	Malignant neoplasm of upper-inner quadrant of left female breast	Anatomic site relevant to surgical history and recurrence surveillance.
`Z85.3`	Personal history of malignant neoplasm of breast	Used when documenting surveillance and history after initial treatment and no current active disease.
`Z85.42`	Personal history of malignant neoplasm of other parts of female genital organs	Included when broader cancer history is relevant to care coordination.
`R97.2`	Elevated tumor marker, other than PSA	May be used when tumor markers are monitored during surveillance and are abnormal (but not diagnostic of progression).

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Common E/M level used for routine disease status surveillance visits in the oncology clinic.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Used when the disease-status visit requires moderate to high complexity medical decision making or more extensive documentation.
`77066`	Diagnostic digital breast tomosynthesis, unilateral or bilateral; without CAD	Imaging commonly performed as part of breast surveillance and documentation of no evidence of local recurrence.
`71260`	CT chest without contrast, for evaluation of pulmonary metastasis	Cross-sectional imaging used to assess for distant metastases when clinically indicated during status evaluation.
`88342`	Immunohistochemistry, per specimen; each additional single antibody stain	Used in pathology to document receptor status (ER/PR) or to clarify tumor characteristics if re-biopsy occurs during surveillance.
`96401`	Chemotherapy administration, subcutaneous or intramuscular; non-hormonal agents, single or initial substance/drug	Relevant if ongoing systemic therapy administration (rare for pure status reporting but common in oncology workflow).