Summary & Overview
HCPCS G9114: Ovarian Cancer Disease Status Assessment
HCPCS Level II code G9114 denotes an oncology disease-status assessment specific to epithelial ovarian cancer at early pathologic stages (stage IA–IB grade 2–3, stage IC all grades, or stage II) with no evidence of progression, recurrence, or metastases. The code is intended for reporting within a Medicare-approved demonstration project and captures surveillance and disease-status documentation for a defined ovarian cancer population. Nationally, standardized reporting of disease status supports care coordination, outcomes measurement, and demonstration project evaluation for oncology services.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context and intended use of the code, the typical service setting and service type, and which payers are relevant to coverage discussions. The publication also outlines benchmarks, policy considerations affecting demonstration-project reporting, and the clinical scenarios where G9114 applies. Data not available in the input is clearly noted where applicable, including specifics on associated taxonomies, ICD-10 mappings, related codes, and payer-specific reimbursement benchmarks.
Billing Code Overview
HCPCS Level II code G9114 describes oncology disease status for ovarian cancer, limited to epithelial cancer with specified pathologic stages: stage IA–IB (grade 2–3), stage IC (all grades), or stage II, without evidence of disease progression, recurrence, or metastases. The code is designated for use in a Medicare-approved demonstration project.
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Service type: Oncology disease status assessment, disease surveillance/monitoring
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Typical site of service: Oncology clinic or outpatient cancer center
Clinical & Coding Specifications
Clinical Context
A 58-year-old woman with a prior diagnosis of epithelial ovarian cancer presents for routine disease-status assessment as part of a Medicare-approved demonstration project. Her initial surgical staging showed pathologic stage IA–IB (grade 2–3) disease, and she completed recommended adjuvant therapy with no clinical or radiographic evidence of progression, recurrence, or metastasis. The oncology team documents disease status during a scheduled outpatient oncology visit coordinated with the gynecologic oncologist and medical oncologist. Workflow includes review of recent history, physical exam focused on abdominal and pelvic findings, laboratory assessment including tumor markers (e.g., CA-125), review of cross-sectional imaging if performed (CT or MRI), and documentation of pathologic stage and current disease-free status in the medical record. The visit is billed using HCPCS Level II code G9114 to indicate disease status assessment for ovarian epithelial cancer meeting the specified pathologic stage criteria within the demonstration project. Typical site of service is an outpatient oncology clinic or gynecologic oncology clinic; services commonly involve oncology nurse coordination, physician or advanced practice provider evaluation, and ordering or review of imaging and labs.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified service | Use when no modifier applies and full service is provided |