Summary & Overview

HCPCS G9117: Ovarian Epithelial Cancer Disease-Status and Staging

HCPCS Level II code G9117 designates a disease-status and staging assessment specific to ovarian epithelial cancer when the extent of disease is unknown, staging is in progress, or disease status is not listed. It is scoped for use in a Medicare-approved demonstration project, signaling restricted or pilot-phase application rather than routine billing across all payers. Nationally, codes like G9117 matter because they support standardized documentation for complex oncology diagnostic workflows and can affect data capture for research and quality measurement.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The report outlines payer coverage patterns, common clinical contexts for use, and implications for billing in demonstration projects. Readers will learn how G9117 is defined clinically, the typical service setting for its use, and where to locate policy updates or demonstration project guidance. The summary also highlights that specifics on associated taxonomies, ICD-10 diagnoses, and related codes are not provided in the input.

This publication is intended to give clinicians, billing professionals, and policy analysts a concise reference to the clinical intent and administrative context of HCPCS Level II code G9117, especially where staging is incomplete or unclear during ovarian epithelial cancer evaluation.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9117HCPCS Level IIoncologyovarian cancerstagingdisease statusdemonstration projectbilling code

Billing Code Overview

HCPCS Level II code G9117 describes a disease-status assessment for ovarian cancer, limited to epithelial cancer, for cases where the extent of disease is unknown, staging is in progress, or the status is not listed. The description specifies use in a Medicare-approved demonstration project, indicating a targeted, project-based utilization rather than routine national coverage.

Service type: Disease status assessment and staging evaluation for ovarian epithelial cancer
Typical site of service: Oncology clinic or hospital-based oncology service involved in staging and diagnostic assessment

Clinical & Coding Specifications

Clinical Context

A 62-year-old woman with a newly suspected ovarian epithelial malignancy presents to a specialty oncology clinic participating in a Medicare-approved demonstration project for enhanced cancer surveillance. Initial evaluation includes history, physical examination, tumor marker testing (e.g., CA-125), pelvic/transvaginal ultrasound and staging workup. Imaging (CT or MRI) has been ordered but final extent of disease is still undetermined; operative staging is planned. The billing code G9117 documents disease status reporting for ovarian cancer limited to epithelial histology when extent of disease is unknown, staging in progress, or not listed, and is used within the demonstration project reporting workflow.

Care pathway: referral from primary care or gynecology → oncology intake visit with documentation of suspected epithelial ovarian cancer → ordering and coordination of diagnostic imaging and labs → multidisciplinary tumor board/staging plan → operative staging or neoadjuvant therapy decision once extent of disease established. Typical site of service: outpatient oncology clinic, hospital outpatient department, or surgical preoperative evaluation within the demonstration project.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (default)	Use when no special billing modifier applies to the service.
`22`	Increased procedural services	Use when services required substantially greater work than typical for the service, documented in the medical record.
`23`	Unusual anesthesia	Use when an otherwise non-anesthesia procedure is performed under general anesthesia for medical reasons.
`52`	Reduced services	Use when the service performed is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	Use when a procedure is started but discontinued due to extenuating circumstances or those that jeopardize patient well-being.
`54`	Surgical care only	Use when only the surgical portion of care is billed separate from pre- or post-operative care.
`55`	Post-operative management only	Use when only postoperative care is billed separate from the surgical procedure.
`56`	Pre-operative management only	Use when only preoperative evaluation and management is billed separate from the surgical procedure.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct operative components.
`AS`	AS modifier (facility)	Use when services are performed in an ambulatory surgical center setting if required by payer.
`CO`	Worker’s compensation payer-specific	Use when the payer responsibility is a worker’s compensation program and payer requires this modifier.
`CQ`	Service furnished under an alternative payment arrangement	Use when services are furnished under certain demonstration or alternative payment models as specified by payer.
`QK`	Medical direction of two, three, or four anesthetists	Use for reporting medical direction in anesthesia when applicable.
`QX`	CRNA service with medical direction by a physician	Use when a certified registered nurse anesthetist provides service with physician medical direction.

Taxonomy Code	Specialty	Notes
`207Q00000X`	Obstetrics & Gynecology	Gynecologic oncologists or general gynecologists involved in diagnosis and operative staging.
`207R00000X`	Surgical Oncology	Surgeons who perform definitive operative staging and cytoreductive procedures.
`207L00000X`	Medical Oncology	Oncologists coordinating systemic therapy and staging decisions.
`208D00000X`	Diagnostic Radiology	Radiologists performing and interpreting cross-sectional imaging for staging.
`363A00000X`	Clinical Laboratory	Pathology/lab services for tumor markers and histopathology confirmation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C56.9`	Malignant neoplasm of ovary, unspecified	Primary code for ovarian malignancy; commonly associated with epithelial ovarian cancer reporting.
`C57.7`	Malignant neoplasm of pelvic peritoneum	Used when disease involves pelvic peritoneum and staging is relevant to extent of spread.
`C79.82`	Secondary malignant neoplasm of ovary	Indicates metastatic disease to the ovary from another primary site, relevant when epithelial origin is uncertain.
`N83.2`	Torsion of ovary, ovarian pedicle	Represents an acute presentation that may prompt surgical exploration and incidental discovery of malignancy.
`R09.89`	Other specified symptoms and signs involving the circulatory and respiratory systems	May be used for non-specific symptoms during initial evaluation but not specific to staging; included when no specific sign code is available.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`58661`	Laparoscopy, surgical, with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)	Common operative procedure for tissue diagnosis and staging when imaging is inconclusive; may follow the disease-status report.
`58952`	Salpingo-oophorectomy for ovarian or adnexal mass, unilateral or bilateral	Performed for definitive management or diagnostic removal of suspected epithelial ovarian tumor.
`58956`	Radical abdominal hysterectomy with bilateral salpingo-oophorectomy and staging	Performed when comprehensive surgical staging and cytoreduction are indicated.
`72192`	MRI pelvis without and with contrast	Cross-sectional imaging frequently used in staging workup when extent of disease is unknown.
`74177`	CT abdomen and pelvis with contrast	Standard imaging for evaluating extent of disease and metastatic spread prior to definitive staging.
`88305`	Surgical pathology, intermediate complexity	Pathology CPT code used for histologic examination of ovarian tumor specimens to confirm epithelial histology.