HCPCS G9087: Colon Cancer, Metastatic or Recurrent Adenocarcinoma

HCPCS Level II code G9087 designates a disease-status category for colon cancer — limited to invasive disease with adenocarcinoma as the predominant histology and with metastatic (m1), locally recurrent, or progressive disease documented by clinical, radiologic, or biochemical evidence. The code is notable for its use in a Medicare-approved demonstration project and for identifying patients with active advanced colon cancer who may be eligible for demonstration-specific reporting or coverage pathways. Nationally, accurate coding for advanced colon cancer supports proper reporting, eligibility determination for demonstration projects, and aggregated program evaluation.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context and service types associated with G9087, typical sites of service where it applies, and which payers are relevant for coverage considerations. The publication also provides benchmarks and policy-relevant insights about using demonstration-oriented HCPCS Level II codes, operational considerations for oncology service lines, and the clinical scenarios that map to this code. Data not available in the input for specific modifiers, taxonomies, ICD-10 pairings, and related procedure codes are noted elsewhere in the full publication.

Billing Code Overview

HCPCS Level II code G9087 identifies a specific oncology disease-status category for colon cancer limited to invasive cancer with adenocarcinoma as the predominant cell type. The description covers patients with metastatic disease or locally recurrent or progressive disease who have clinical, radiologic, or biochemical evidence of active disease and were m1 at diagnosis. This code was defined for use in a Medicare-approved demonstration project.

Service type: Oncology — disease status assessment and classification

Typical site of service: Hospital outpatient oncology clinics, cancer centers, and other ambulatory oncology settings

Clinical Context

A 62-year-old patient with a prior diagnosis of adenocarcinoma of the colon presents to an oncology clinic with progressive weight loss, new-onset right upper quadrant pain, and rising carcinoembryonic antigen (CEA) levels. Imaging (CT chest/abdomen/pelvis) demonstrates hepatic lesions consistent with metastatic disease and a locally recurrent primary tumor at the colon anastomosis. The oncology team documents current clinical, radiologic, and biochemical evidence of disease consistent with stage IV colon cancer (M1). The patient is enrolled in a Medicare-approved demonstration project that requires reporting of disease status using the HCPCS Level II code G9087 for colon cancer, invasive adenocarcinoma predominant, metastatic/locally recurrent/progressive disease.

Clinical workflow:

Referral and intake: Medical oncology or colorectal surgery documents history, prior treatments, and enrollment in the demonstration project.
Diagnostic confirmation: Relevant labs (CEA), cross-sectional imaging, and review of prior pathology confirm active disease.
Encounter documentation: The clinician documents site(s) of metastatic disease, evidence of progression or recurrence, and the clinical intent (palliative systemic therapy, clinical trial eligibility, or symptom-directed care). The visit is coded with G9087 to indicate disease status for the demonstration project, alongside applicable evaluation and management or procedural CPT codes for treatment or supportive interventions.
Billing and modifiers: The claim for G9087 is submitted per project requirements; appropriate modifiers (for example 00 for global, or anesthesia/assist modifiers when relevant) are appended to associated CPT procedures as indicated by service delivery.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no special circumstances apply to the billed service and coding is submitted as standard for the demonstration project.
`22`	Increased procedural services	Use with related CPT procedures when work required is substantially greater than typically required.
`23`	Unusual anesthesia	Use when a procedure is performed under general anesthesia because of extenuating circumstances.
`52`	Reduced services	Use when a service or procedure is partially reduced or eliminated at the physician's discretion.
`53`	Discontinued procedure	Use when a procedure is started but discontinued due to extenuating circumstances or patient condition.
`54`	Surgical care only	Use on surgical procedure claims when another provider bills for pre- and postoperative care.
`55`	Postoperative management only	Use when only postoperative care is provided by the billing practitioner.
`56`	Preoperative management only	Use when only preoperative care is provided by the billing practitioner.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of a procedure.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	Use when an APP provides assistant-at-surgery services, where permitted.
`CO`	Chip-only MAC jurisdiction	Use for chemotherapy administration services in jurisdictions requiring this modifier (context-specific payer rules).
`CQ`	Service furnished by a CRNA without medical direction by a physician	Use when a certified registered nurse anesthetist provides anesthesia without physician direction.
`FX`	Service split between multiple locations (modifier used in some demonstration projects)	Use when a service is split between locations as defined by project rules.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals	Use when the physician medically directs multiple concurrent anesthesia cases.
`QX`	CRNA service with anesthesiologist present but not medically directing	Use when CRNA performs service with anesthesiologist present but not directing.
`QY`	Medical direction of one CRNA by an anesthesiologist	Use when an anesthesiologist medically directs the CRNA for a single case.

Taxonomy Code	Specialty	Notes
207RC0000X	Medical Oncology	Primary specialty managing systemic therapy and longitudinal cancer care.
207RX0400X	Hematology/Oncology	Combined specialty often responsible for chemotherapy and disease-status documentation.
208000000X	General Surgery (Colorectal Surgery)	Surgeons managing primary tumor resection, local recurrence assessment, and surgical palliation.
207Q00000X	Radiation Oncology	Specialists providing palliative or curative radiotherapy for locoregional disease control.
363L00000X	Interventional Radiology	Performs image-guided biopsies, ablations, or hepatic-directed procedures relevant to metastatic disease.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C18.9`	Malignant neoplasm of colon, unspecified	Represents primary colon adenocarcinoma when the specific subsite is not documented; commonly associated with metastatic disease reporting.
`C18.7`	Malignant neoplasm of sigmoid colon	A common primary site for adenocarcinoma that can metastasize and be reported with `G9087`.
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	Reflects hepatic metastases from colon cancer, a frequent site of spread and a key element of disease-status documentation.
`C79.81`	Secondary malignant neoplasm of bone	Indicates osseous metastasis from colon primary; relevant when documenting extent of metastatic disease.
`C78.6`	Secondary malignant neoplasm of retroperitoneum and peritoneum	Represents peritoneal carcinomatosis or nodal metastasis relevant to locally recurrent or progressive disease.
`K63.5`	Polyp of colon	Included when surveillance or pathologic correlation is required; may be present in clinical history but less specific for metastatic disease.
`Z85.038`	Personal history of other malignant neoplasm of large intestine	Used in longitudinal records to indicate past colon malignancy when documenting recurrence or progression.
`R97.8`	Other abnormal tumor markers	Reflects rising tumor markers such as CEA that support biochemical evidence of progressive disease when combined with imaging and clinical findings.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96413`	Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for primary infusion)	Used during systemic chemotherapy treatment visits following documentation of metastatic colon cancer status coded with `G9087`.
`96365`	Intravenous infusion, therapeutic, prophylactic, or diagnostic injection; initial, up to 1 hour	Used for initial drug infusion visits associated with systemic therapy for metastatic colon cancer.
`74350`	CT abdomen and pelvis with contrast (single or multiphase)	Cross-sectional imaging commonly performed to document metastatic disease and assess response; often billed in the diagnostic workup accompanying `G9087`.
`76700`	Ultrasound, abdominal, real time with image documentation; complete	May be used for targeted liver lesion assessment or procedural guidance for biopsy or drainage.
`47000`	Biopsy of liver, percutaneous, with imaging guidance	Performed to obtain tissue confirmation of metastatic disease when needed prior to therapy decisions; complements disease-status reporting.

OpenPayer

Summary & Overview