Summary & Overview
HCPCS G9080: Prostate Cancer Disease-Status Assessment After Initial Treatment
HCPCS Level II code G9080 denotes an oncology disease-status assessment specific to prostate adenocarcinoma provided after initial treatment when there is a rising prostate-specific antigen (PSA) level or failure of PSA decline. The code is designated for use in a Medicare-approved demonstration project and represents a targeted post-treatment evaluation to determine disease status and guide subsequent management decisions. Nationally, services that track post-treatment recurrence or progression in prostate cancer are a critical component of oncology care pathways and can affect utilization of imaging, systemic therapy, and surveillance resources.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical site of service, and the policy setting (demonstration project). The publication also outlines expected benchmarks and reporting considerations where available, summarizes relevant policy implications for coverage and reimbursement under major payers, and places the code in clinical context for prostate cancer surveillance after initial therapy. Data not available in the input is noted where applicable, and readers will gain a clear, national-level understanding of what G9080 represents and why it matters for oncology billing and post-treatment prostate cancer management.
Billing Code Overview
HCPCS Level II code G9080 describes a disease-status assessment service for prostate cancer, limited to adenocarcinoma, provided after initial treatment when there is a rising PSA or failure of PSA decline. The description specifies use in a Medicare-approved demonstration project, indicating this code applies to services delivered under that demonstration context.
Service Type: Oncology — disease status assessment
Typical Site of Service: Oncology clinic or outpatient specialty center, where post-treatment disease-status evaluations and PSA monitoring are performed.
Clinical & Coding Specifications
Clinical Context
A typical patient is a man with a history of prostate adenocarcinoma previously treated with definitive therapy (radical prostatectomy, radiation therapy, or primary androgen deprivation). He presents to a specialty oncology clinic participating in a Medicare-approved demonstration project because serial prostate-specific antigen (PSA) testing shows a rising PSA or failure of expected PSA decline after initial treatment. The treating team includes a medical oncologist or radiation oncologist who documents disease status assessment focused on biochemical recurrence versus persistent disease. Evaluation typically includes review of prior pathology and treatment records, serial PSA values, physical exam including digital rectal exam if applicable, and ordering of or reviewing prostate imaging (multiparametric MRI, PSMA PET/CT when available) and bone scan as indicated. The clinical workflow for the service billed with G9080 includes verifying Medicare demonstration project enrollment, confirming the indication (adenocarcinoma limited to prostate origin), documenting rising or non-declining PSA after initial therapy, performing disease status assessment, and recording findings and plan in the medical record. Typical sites of service are outpatient oncology clinic, hospital outpatient department, or specialized cancer center participating in the demonstration project. Common patient interactions include counseling about disease status, discussing further diagnostic imaging or biopsy if indicated, and coordinating referrals for salvage therapy or systemic treatment planning.
Coding Specifications
| Modifier | Description | When to Use |
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