Summary & Overview
HCPCS G9103: Gastric Cancer Adenocarcinoma, Metastatic Disease Status
HCPCS Level II code G9103 designates an oncology disease-status assessment for patients with gastric cancer when adenocarcinoma is the predominant histology and the disease is metastatic, locally recurrent, progressive, or clinical/pathologic m1 at diagnosis. The code is intended for use in a Medicare-approved demonstration project, signaling a focused application in research and policy-testing environments. Nationally, this code matters because it identifies encounters tied to advanced gastric adenocarcinoma disease-status evaluation, which has implications for coverage policies, reporting within demonstration projects, and tracking the utilization of oncology assessment services in advanced disease.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for G9103, the service type and typical sites where the service is provided, and guidance on what to expect in payer coverage discussions. The publication also outlines benchmarks and policy-related considerations relevant to demonstration-project billing, as well as clinical context for metastatic gastric adenocarcinoma disease-status evaluation. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code G9103 describes an oncology disease status assessment for gastric cancer, limited to cases where adenocarcinoma is the predominant cell type and the disease is clinical or pathologic m1 at diagnosis, metastatic, locally recurrent, or progressive. This code is specified for use within a Medicare-approved demonstration project.
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Service type: Oncology disease status assessment
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Typical site of service: Hospital outpatient department, oncology clinic, or other settings providing cancer disease-status evaluation and management for metastatic or recurrent gastric adenocarcinoma
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with gastric adenocarcinoma presents with weight loss, progressive epigastric pain, and imaging showing hepatic lesions. The oncology team documents clinical M1 disease at diagnosis and enrolls the patient in a Medicare-approved demonstration project for advanced gastric cancer management. The clinical workflow includes multidisciplinary evaluation (medical oncology, surgical oncology, gastroenterology, radiology, and pathology); confirmation of adenocarcinoma histology by endoscopic biopsy and pathology; staging with contrast-enhanced CT or PET/CT; discussion of systemic therapy options; documentation of metastatic or locally recurrent disease status in the medical record; and submission of the oncology demonstration project billing using G9103. Ancillary services (infusion nursing, supportive care, palliative consultations) are coordinated, and treatment response or progression is reassessed at regular intervals with imaging and clinic visits. Documentation includes the diagnosis, metastatic status (M1), tumor histology (adenocarcinoma predominant), demonstration project enrollment, and relevant consent records for use of G9103 in billing.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no specific modifier applies to the service billed with . |