Summary & Overview
HCPCS G9074: Invasive Female Breast Adenocarcinoma, Stage IIIA–IIIB, ER/PR Negative
HCPCS Level II code G9074 designates a narrowly defined oncology disease-status: invasive female breast adenocarcinoma, stage IIIA–IIIB (excluding T3, N1, M0), ER/PR negative, with no evidence of progression, recurrence, or metastasis. It is authored for use in a Medicare-approved demonstration project to standardize classification in that specific research or pilot context. This code matters nationally because it enables precise reporting of a clinically and prognostically important subgroup of breast cancer patients for demonstration studies, supports uniform case classification, and can affect programmatic eligibility and data collection for outcomes research.
Key payers in the national context include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview, explanation of typical service settings, and a summary of the policy and administrative implications tied to demonstration-project use. The publication highlights how the code narrows patient selection by histology (adenocarcinoma predominant), stage, hormone receptor status, and absence of progression — critical elements for registry, quality measurement, and demonstration reporting. Data not available in the input are noted where applicable. The piece is intended to inform billing staff, oncology administrators, and policy analysts on the code’s scope and practical documentation context without providing clinical or billing advice.
Billing Code Overview
HCPCS Level II code G9074 describes a specific oncology disease-status designation for invasive female breast cancer. The full descriptor specifies adenocarcinoma as the predominant cell type, clinical stage IIIA–IIIB (excluding T3, N1, M0), and estrogen receptor (ER) and progesterone receptor (PR) negative disease. The code applies when there is no evidence of disease progression, recurrence, or metastases and is intended for use within a Medicare-approved demonstration project.
Service type: Oncology disease-status assessment and classification.
Typical site of service: Cancer centers, hospital outpatient departments, oncology clinics, or other ambulatory oncology settings where staging and disease-status documentation are performed for clinical care or demonstration projects.
Clinical & Coding Specifications
Clinical Context
A 58-year-old woman with a history of invasive female breast cancer (adenocarcinoma predominant) presents for participation in a Medicare-approved demonstration project assessing disease status. Her prior pathology confirmed stage IIIA–IIIB disease (excluding T3, N1, M0 patterns) and estrogen receptor and progesterone receptor negative status. She has completed definitive local therapy and systemic treatment and currently has no clinical or radiographic evidence of progression, recurrence, or metastasis. The clinical workflow includes: initial oncology intake and chart review; confirmation of prior staging and receptor status from pathology and operative reports; focused history and physical exam; review of surveillance imaging (mammography, diagnostic ultrasound, and/or staging CT/PET if indicated); documentation of disease-free status in the medical record; and entry of the HCPCS Level II billing code G9074 for the demonstration project submission. Typical sites of service are outpatient oncology clinics, cancer center ambulatory clinics, and hospital-based outpatient departments participating in the Medicare demonstration. Common patient interactions include scheduled survivorship visits, surveillance imaging review sessions, multidisciplinary tumor board confirmations, and documentation visits for research or registry reporting tied to the demonstration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier |