Summary & Overview
HCPCS G9113: Ovarian Epithelial Cancer, Pathologic Stage IA–IB (Grade 1)
HCPCS Level II code G9113 designates a disease-status category for epithelial ovarian cancer at pathologic stage IA–IB (grade 1) with no evidence of progression, recurrence, or metastasis. Intended for use in a Medicare-approved demonstration project, the code identifies a low-stage, early-grade ovarian cancer population for reporting within programmatic clinical or research initiatives. Nationally, such codes matter for monitoring enrollment, outcomes, and quality measurement in demonstration projects and registries where precise disease-state capture supports program evaluation and resource allocation.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context, the service type and typical sites where G9113 would be used, and guidance on what information is present or absent in available inputs. The publication outlines benchmarks and policy-relevant considerations for demonstration project reporting, summarizes the administrative purpose of the code, and highlights areas where additional coding or diagnosis detail is needed.
Data not available in the input is explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code G9113 denotes a disease status classification for ovarian cancer, specifically epithelial ovarian cancer at pathologic stage IA–IB (grade 1) with no evidence of disease progression, recurrence, or metastases. The code is designated for use within a Medicare-approved demonstration project and captures a defined oncologic disease state rather than a discrete procedure or treatment.
Service Type: Oncology disease status assessment / disease-state reporting
Typical Site of Service: Hospital outpatient oncology clinics, cancer centers, and clinical trial or demonstration project settings
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 58-year-old woman with a prior diagnosis of epithelial ovarian carcinoma (pathologic stage IA–IB, grade 1) presents for routine surveillance within a Medicare-approved demonstration project. She has completed primary surgical staging and is without clinical or radiographic evidence of disease progression, recurrence, or metastasis. The clinical workflow includes a focused oncology visit documenting disease status, review of recent pelvic imaging (transvaginal ultrasound or CT/MRI when indicated), review of tumor markers (for example, CA-125 if previously elevated), physical exam including pelvic exam, and documentation of pathology and surgical staging details confirming stage IA–IB epithelial histology and grade 1. Encounter documentation explicitly states “no evidence of disease progression, recurrence, or metastases” and references the original pathologic stage. Care is typically provided in an outpatient oncology clinic or hospital-based clinic by a gynecologic oncologist or medical oncologist participating in the Medicare demonstration project. The visit may result in continued surveillance scheduling, documentation for the demonstration project, or referrals for additional testing only if clinical changes are detected.
Coding Specifications
| Modifier | Description | When to Use |
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