Summary & Overview
HCPCS G9105: Pancreatic Adenocarcinoma Disease Status Assessment, Post R0 Resection
HCPCS Level II code G9105 denotes an oncology disease status assessment specific to pancreatic cancer where adenocarcinoma is the predominant histology, applied to patients after an R0 resection with no evidence of progression, recurrence, or metastasis. The code is designated for use within a Medicare-approved demonstration project and captures surveillance encounters focused on confirming disease-free status after curative-intent surgery. Nationally, the code matters for tracking post-surgical surveillance practices, demonstration-project reporting, and aligning billing with clinical follow-up pathways for a high-morbidity cancer.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the clinical context of the code, typical sites of service, and the service type it represents. The publication summarizes expected use cases for claims and reporting in demonstration settings, describes common modifiers associated with HCPCS billing generally (input provided separately), and highlights areas where policy updates or payer-specific demonstration guidance can affect claim submission and reimbursement workflows.
The report is intended for a national audience of billing professionals, oncology clinicians, and policy analysts seeking concise guidance on the purpose and clinical framing of G9105, along with what to expect when this code is encountered in demonstration-project billing and reporting workflows.
Billing Code Overview
HCPCS Level II code G9105 describes a disease status assessment for pancreatic cancer, limited to cases where adenocarcinoma is the predominant cell type. The code applies to patients who are post R0 resection with no evidence of disease progression, recurrence, or metastases, and is intended for use in a Medicare-approved demonstration project.
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Service type: Oncology disease status assessment
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Typical site of service: Outpatient oncology clinic or hospital outpatient department for post-surgical surveillance
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with biopsy-proven pancreatic ductal adenocarcinoma underwent definitive surgical resection (R0 pancreaticoduodenectomy). After surgery and completion of any indicated adjuvant therapy, the patient is enrolled in a Medicare-approved demonstration project to monitor disease status. Routine follow-up visits occur in a multidisciplinary oncology clinic and include review of history and physical, tumor marker assessment (e.g., CA 19-9), cross-sectional imaging (contrast-enhanced CT or MRI), and documentation that there is no evidence of disease progression, local recurrence, or distant metastases. The clinical workflow includes: pre-visit collection of recent imaging and labs, an outpatient oncology or surgical follow-up visit to document exam and review results, potential tumor board review if any equivocal findings arise, and formal documentation of disease-free status to meet demonstration project reporting requirements. Typical sites of service are outpatient hospital-based oncology clinic, ambulatory surgical center for follow-up procedures if needed, and hospital outpatient radiology for imaging studies.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no special status or circumstance applies to the service. |
22 |