Summary & Overview
HCPCS G9094: Rectal Cancer, Invasive Adenocarcinoma with Metastatic or Recurrent Disease
HCPCS Level II code G9094 identifies a disease-status classification for rectal cancer characterized by invasive disease with adenocarcinoma as the predominant cell type and documented metastatic (m1), locally recurrent, or progressive disease. The code is designated for use in Medicare-approved demonstration projects and supports standardized reporting of advanced rectal cancer status in oncology care. Nationally, clear classification codes like G9094 matter for clinical tracking, eligibility determinations within demonstration programs, and consistent documentation across cancer care settings.
Key payers 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 meaning, typical sites of service, and the policy context for its use in demonstration projects. The publication provides benchmarks where available, outlines relevant billing and reporting considerations tied to demonstration participation, and summarizes clinical context for advanced rectal adenocarcinoma as it relates to administrative classification. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code G9094 denotes a clinical oncology classification for rectal cancer where the disease is limited to invasive cancer with adenocarcinoma as the predominant cell type and with documented metastatic (m1) disease at diagnosis, or disease that is metastatic, locally recurrent, or progressive. The code is intended for use within 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: Oncology clinics, hospital outpatient departments, or other cancer care settings participating in Medicare demonstration projects
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old person with biopsy-proven rectal adenocarcinoma who presents with metastatic disease at diagnosis (M1) or with locally recurrent/progressive tumor following prior therapy. The patient is enrolled in a Medicare-approved demonstration project tracking oncology disease status and outcomes. Clinical workflow includes multidisciplinary evaluation by medical oncology, radiation oncology, and colorectal surgery. Initial staging with contrast-enhanced CT chest/abdomen/pelvis and pelvic MRI documents metastatic or locally recurrent disease. Diagnostic confirmation and biomarker testing (mismatch repair/MSI, RAS, BRAF) are completed on tumor tissue. Treatment planning visits document disease status (metastatic, locally recurrent, or progressive) and determine systemic chemotherapy, targeted therapy, immunotherapy, palliative radiation, or surgical interventions. Disease-status assessments are updated at scheduled intervals and recorded in the medical record for demonstration project reporting, billing, and quality measurement. Typical site of service is outpatient oncology clinic, infusion center, or hospital outpatient department for evaluations, imaging review, and treatment administration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard service | Use when no special circumstance modifier applies |