Summary & Overview
HCPCS G9084: Colon Cancer Disease Status, Adenocarcinoma
HCPCS Level II code G9084 denotes a disease status assessment for colon cancer cases where invasive adenocarcinoma is the predominant cell type and initial staging is recorded as t1-3, n0, m0 with no evidence of progression, recurrence, or metastasis. It is earmarked for use within a Medicare-approved demonstration project, signaling its role in targeted quality measurement or pilot program reporting. Nationally, this code matters for tracking clinical outcomes and standardized staging documentation in select oncology demonstration initiatives.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical intent and administrative scope of the code, typical sites of service, and the policy context surrounding demonstration-project codes. The publication summarizes expected documentation elements, payer relevance, and the administrative considerations that providers should be aware of when this code is reported.
This report also outlines what to expect in benchmarking and policy updates related to demonstration-project HCPCS codes, clarifies the clinical setting for use, and points to areas where additional data or payer-specific guidance is commonly required. Data not available in the input for payor-specific adjudication rules, associated taxonomies, and ICD-10 mappings is noted when applicable.
Billing Code Overview
HCPCS Level II code G9084 describes a disease status assessment for colon cancer, limited to invasive cancer with adenocarcinoma as the predominant cell type. The description specifies that the extent of disease was initially established as t1-3, n0, m0 with no evidence of disease progression, recurrence, or metastases. This code is designated for use in a Medicare-approved demonstration project.
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Service type: Oncology disease status assessment and documentation
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Typical site of service: Outpatient oncology clinic or specialty cancer center
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a history of surgically resected stage T2N0M0 colon adenocarcinoma participates in a Medicare-approved demonstration project monitoring disease status. The patient presents for scheduled surveillance evaluation after initial therapy, including physical exam, review of imaging (CT chest/abdomen/pelvis), tumor markers (CEA), and colonoscopic surveillance. The clinical workflow includes outpatient oncology visit, documentation of no evidence of disease progression, recurrence, or metastasis, review and reconciliation of pathology and staging (limited to invasive adenocarcinoma, predominant cell type), and formal recording of disease status as t1-3, n0, m0 in the medical record for submission under billing code G9084. Typical sites of service are hospital outpatient departments or freestanding oncology clinics participating in the Medicare demonstration. Common patient interactions include provider history and exam, chart review of prior surgical and pathology reports, coordination with radiology for imaging review, and generation of the disease status report for the demonstration project.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifiers apply |