HCPCS G9115: Ovarian Cancer Disease Status, Epithelial Stage III–IV - OpenPayer

Summary & Overview

HCPCS G9115: Ovarian Cancer Disease Status, Epithelial Stage III–IV

HCPCS Level II code G9115 documents disease status for ovarian cancer limited to epithelial histology at pathologic stage III–IV, recorded when there is no evidence of progression, recurrence, or metastases; it is designated for use in a Medicare-approved demonstration project. The code captures a specific clinical surveillance designation rather than a procedure or treatment event, and its use matters for standardized reporting of advanced-stage ovarian cancer outcomes in demonstration settings.

Key national payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent and service context, discussion of which payers typically recognize such demonstration-oriented HCPCS codes, and an outline of implications for claims reporting and clinical documentation. Where available, benchmarking and coverage notes are presented alongside policy considerations relevant to demonstration project reporting and oncology surveillance workflows.

This publication provides clinicians, billing staff, and policy analysts with practical context for HCPCS Level II code G9115, clarifies the expected site-of-service and clinical scenario for its use, and summarizes the areas where further payer-specific guidance or demonstration-project instructions are commonly required.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9115HCPCS Level IIoncologyovarian cancerdisease statussurveillancedemonstration projectoutpatient oncology

Billing Code Overview

HCPCS Level II code G9115 describes an oncology-related disease status entry for ovarian cancer, limited to epithelial cancer, pathologic stage III–IV, without evidence of progression, recurrence, or metastases. The code is specified for use in a Medicare-approved demonstration project.

Service type: Oncology disease status assessment / surveillance

Typical site of service: Oncology clinic or outpatient cancer center

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 62-year-old woman with a prior diagnosis of epithelial ovarian cancer (pathologic stage III) is enrolled in a Medicare-approved oncology demonstration project to document disease status during routine survivorship surveillance. She presents to a gynecologic oncology clinic for a scheduled follow-up visit after completing primary cytoreductive surgery and platinum-based chemotherapy. The interdisciplinary visit includes a focused history for symptoms (abdominal pain, bloating, early satiety), physical exam with abdominal and pelvic assessment, review of tumor markers (CA-125), and imaging review (CT or transvaginal ultrasound) performed prior to or during the visit. The clinical workflow commonly includes verification of enrollment in the demonstration project, documentation that there is no evidence of progression, recurrence, or metastases, updating problem lists and staging, and coding the visit for program reporting using G9115. Typical site of service is an outpatient hospital-based oncology clinic or ambulatory surgery center when linked to surveillance procedures; telehealth follow-up could be used for symptom review but the billing descriptor for G9115 is tied to the demonstration project visit documenting disease status rather than a telehealth-only encounter.

Coding Specifications

Modifier	Description	When to Use
`00`

HCPCS G9383: HCV Screening Within 12-Month Reporting Period

HCPCS-G9774-POST-HYSTERECTOMY-PATIENT-STATUS

HCPCS G9774: Patient Status, Post-Hysterectomy

HCPCS-G9670-MULTIPLE-CHRONIC-CONDITIONS-QUALITY-ACTIONS-COMPLETE

HCPCS G9670: All Quality Actions Completed for Multiple Chronic Conditions

HCPCS-G9585-OPIOID-RISK-SCREENING-NOT-DONE

HCPCS G9585: Opioid Risk Screening Not Completed

HCPCS-G2125-FRAILTY-IDENTIFICATION-AGE-81-PLUS

HCPCS G2125: Frailty Identification in Patients Aged 81 and Older

HCPCS-G2190-HEADACHE-RADIATING-TO-NECK-IMAGING

HCPCS G2190: Head Imaging for Headache Radiating to Neck

HCPCS-G9429-PATHOLOGY-DOCUMENTATION-MISSING-TUMOR-FEATURES

HCPCS G9429: Documentation for Missing Tumor Pathology Elements

HCPCS-G2157-PNEUMOCOCCAL-VACCINE-SEQUENCE-AGES-60-PLUS

HCPCS G2157: Pneumococcal Vaccine Sequence, Age 60+

HCPCS-G9153-MAPCP-PHYSICIAN-INCENTIVE-POOL

HCPCS G9153: Mapcp Demonstration Physician Incentive Pool

HCPCS-G9938-INSTITUTIONAL-SNP-LONG-TERM-CARE-RESIDENCY-66-PLUS

HCPCS G9938: Institutional SNP Enrollment and Long-Term Care Residency, Age 66+

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
`207RH0000X`	Obstetrics & Gynecology	Gynecologic oncologists and general OB/GYNs manage ovarian cancer surveillance and disease-status visits.
`208800000X`	Hematology & Oncology	Medical oncologists coordinate systemic therapy follow-up and surveillance documentation.
`2080P0207X`	Gynecologic Oncology	Subspecialists focusing on ovarian cancer surgery and survivorship care.
`363L00000X`	Nurse Practitioner	Advanced practice clinicians commonly perform follow-up visits and documentation in oncology clinics.
`367500000X`	Physician Assistant	PAs support clinic visit workflows, documentation, and coordination of surveillance testing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C56.9`	Malignant neoplasm of ovary, unspecified	Primary diagnosis code for epithelial ovarian cancer surveillance and staging documentation.
`C56.1`	Malignant neoplasm of right ovary	Specific laterality when right ovarian primary is documented; used for accurate staging and surveillance.
`C56.2`	Malignant neoplasm of left ovary	Specific laterality when left ovarian primary is documented; used for accurate staging and surveillance.
`C57.4`	Malignant neoplasm of adnexa, unspecified	Used when tumor involves adnexal structures adjacent to the ovary and included in status assessment.
`Z85.43`	Personal history of malignant neoplasm of ovary	Used in survivorship documentation when history of treated ovarian cancer is present without active disease.
`Z08`	Encounter for follow-up examination after completed treatment for malignant neoplasm	Used to indicate routine post-treatment surveillance visits documenting absence of recurrence or progression.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Common for intermediate-complexity surveillance visits documenting disease status and care planning alongside `G9115` reporting.
`88305`	Level IV surgical pathology, gross and microscopic examination	Used when pathology specimens from prior surgery are reviewed or re-reviewed during disease-status assessment.
`74177`	Computed tomography, abdomen and pelvis with contrast	Frequently obtained to assess for recurrent disease or metastases during surveillance visits documented with `G9115`.
`76641`	Ultrasound, transvaginal	Performed as part of pelvic imaging to evaluate adnexal structures when assessing for recurrence.
`86304`	Antigen; tumor/cancer (e.g., CA 125)	Laboratory tumor marker measurement commonly used to monitor epithelial ovarian cancer status during follow-up.
`99510`	Routine follow-up of patient in outpatient setting (note: placeholder for care coordination codes)	Used for care coordination and survivorship planning activities associated with the demonstration project visit.

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