Summary & Overview
HCPCS G9123: CML Chronic Phase Not in Remission
HCPCS Level II code G9123 designates a disease-status classification for patients with chronic myelogenous leukemia (CML) who are Philadelphia chromosome positive and/or BCR-ABL positive and are in the chronic phase not in hematologic, cytogenetic, or molecular remission. The code is specified for use in a Medicare-approved demonstration project, reflecting its role in tracking disease states in oncology populations and supporting programmatic evaluation. Nationally, standardized disease-status codes like G9123 matter for consistent reporting in demonstrations, quality initiatives, and for aligning clinical documentation with program requirements.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical meaning of the code, likely sites of service where it applies, and what to expect when this code appears in claims for demonstration or program reporting. The publication summarizes benchmarks and policy-relevant considerations tied to demonstration projects and provides clinical context about CML disease-state classification. Data not available in the input are noted where applicable and the reader will not find payer-specific rate tables in this summary.
Billing Code Overview
HCPCS Level II code G9123 indicates a disease status classification for oncology patients with chronic myelogenous leukemia (CML) that is limited to Philadelphia chromosome positive and/or BCR-ABL positive disease. The descriptor specifies the chronic phase not in hematologic, cytogenetic, or molecular remission and notes use for a Medicare-approved demonstration project.
Service type: Oncology disease-status assessment / reporting
Typical site of service: Oncology clinic or hospital outpatient setting, where disease-status evaluations and reporting for CML are performed as part of clinical management and demonstration-project data collection.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a documented Philadelphia chromosome–positive chronic myelogenous leukemia (CML) in the chronic phase presents to a specialized oncology clinic participating in a Medicare-approved demonstration project. The patient is receiving outpatient targeted therapy (e.g., a tyrosine kinase inhibitor) and is evaluated for disease status because hematologic, cytogenetic, and molecular remission have not been achieved. The oncology team documents current symptoms, recent complete blood count results, peripheral blood smear, bone marrow aspirate/biopsy results (if performed), and BCR-ABL quantitative PCR trends. Clinical workflow includes scheduling an oncology evaluation visit, collecting laboratory samples for CBC and BCR-ABL transcript level, reviewing prior cytogenetic reports, documenting response to therapy and adverse effects, and entering the disease status designation in the medical record. Billing uses the HCPCS Level II code G9123 to indicate oncology disease status for CML chronic phase not in hematologic, cytogenetic, or molecular remission as part of the Medicare demonstration project. Typical site of service is an outpatient oncology clinic or hospital outpatient department with coordinated laboratory services and oncology nursing support.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no additional modifier applies and service is billed as reported. |