Summary & Overview
HCPCS G9077: Prostate Cancer Disease Status, Localized Adenocarcinoma
HCPCS Level II code G9077 designates a disease-status category for prostate cancer limited to adenocarcinoma as the predominant histology, clinical stages T1–T2c, Gleason scores 2–7, and prostate-specific antigen (PSA) ≤20 at diagnosis, with no evidence of progression, recurrence, or metastasis. The code is specified for use within a Medicare-approved demonstration project and is intended to standardize reporting of early, localized prostate cancer meeting these clinical criteria. Nationally, precise disease-status coding informs quality measurement, research in demonstration projects, and program evaluation.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical intent, typical service setting, and implications for documentation and reporting in demonstration contexts. The publication covers benchmarking considerations where available, relevant policy context for Medicare demonstration projects, and the clinical criteria embedded in the code description. Data not available in the input are clearly noted where applicable.
Billing Code Overview
HCPCS Level II code G9077 describes an oncology disease-status classification specific to prostate cancer. The code applies when adenocarcinoma is the predominant cell type, tumors are staged T1 through T2c, Gleason score is between 2 and 7, and prostate-specific antigen (PSA) is less than or equal to 20 at diagnosis with no evidence of disease progression, recurrence, or metastases. The description indicates this classification is used in the context of a Medicare-approved demonstration project.
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Service type: Oncology disease-status classification and reporting
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Typical site of service: Outpatient oncology clinics or other ambulatory settings participating in a Medicare-approved demonstration project
Clinical & Coding Specifications
Clinical Context
A 68-year-old man with biopsy-proven prostate adenocarcinoma (predominant cell type adenocarcinoma) presents for enrollment and follow-up in a Medicare-approved demonstration project monitoring disease status. At diagnosis his tumor is clinical stage T1–T2c, Gleason score 2–7, and prostate-specific antigen (PSA) ≤ 20 ng/mL. There is no clinical, imaging, or laboratory evidence of disease progression, recurrence, or metastases. The clinical workflow includes: initial oncologic evaluation by a medical or radiation oncologist and urologist; documentation of staging (T1–T2c), Gleason grade, and PSA value; multidisciplinary tumor board review if applicable; enrollment consent for the demonstration project; periodic surveillance visits with PSA testing, digital rectal exam, and symptom review; imaging only if clinical concern arises; and documentation that the patient continues to meet eligibility criteria for disease-limited status. Typical sites of service include outpatient oncology clinics, urology clinics, and ambulatory care centers participating in the Medicare demonstration project.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Reserved / Not used for Medicare reporting | Not used for this code; present for administrative completeness |
22 |