Summary & Overview
HCPCS G9106: Pancreatic Adenocarcinoma Post-Resection Disease Status
HCPCS Level II code G9106 designates an oncology disease-status assessment for patients with pancreatic adenocarcinoma who are post R1 or R2 surgical resection and have no evidence of disease progression or metastases. The code is specified for use in a Medicare-approved demonstration project, signaling a focused application in post-operative surveillance protocols for a high-risk cancer population. Nationally, this code matters because it standardizes reporting for a narrowly defined clinical scenario in pancreatic cancer care and supports demonstration efforts that may influence broader coverage and quality measurement.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the clinical context and service setting for which the code is used, an outline of typical payers' roles, and an overview of what to expect in related documentation and billing practice. The publication also highlights where input data is not available and identifies areas—such as modifiers, associated taxonomies, ICD-10 mappings, related codes, and service line details—where further information would be required for complete billing implementation.
This summary is intended for clinicians, coding professionals, and policy analysts seeking concise guidance on the purpose and national relevance of G9106, and what topics to pursue next for operational and policy considerations.
Billing Code Overview
HCPCS Level II code G9106 represents a disease status assessment for pancreatic cancer, limited to adenocarcinoma, specifically for patients who are post R1 or R2 resection with no evidence of disease progression or metastases. The description indicates this code is intended 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 or oncology clinic visit for post-operative surveillance
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with pancreatic adenocarcinoma undergoes an oncologic surgical resection that results in microscopic or macroscopic residual tumor (R1 or R2). Following surgery, the patient is enrolled in a Medicare-approved demonstration project monitoring disease status without evidence of interval progression or distant metastases. The clinical workflow includes routine postoperative surveillance visits with an oncology clinician—medical oncologist or surgical oncologist—to assess performance status, review pathology and imaging, coordinate adjuvant therapy as appropriate, and document disease status. Typical visits occur in an outpatient oncology clinic or hospital-based cancer center. Imaging (contrast-enhanced CT or MRI), tumor marker assessments (e.g., CA 19-9), and multidisciplinary tumor board review are often part of the follow-up pathway. Documentation in the medical record should state the cancer type (pancreatic adenocarcinoma), surgical margin status (post R1 or R2 resection), lack of progression or metastases at the time of assessment, enrollment in the demonstration project, and the clinical decision or planned next steps (surveillance interval, adjuvant therapy, supportive care).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no special modifier applies to the service. |