Summary & Overview
HCPCS G9125: CML Philadelphia/BCR-ABL Positive, Blast Phase Not in Remission
HCPCS Level II code G9125 designates a disease-status classification for chronic myelogenous leukemia (CML) in patients who are Philadelphia chromosome positive and/or BCR-ABL positive and whose blast phase is not in hematologic, cytogenetic, or molecular remission. The code is specified for use in a Medicare-approved demonstration project and serves to standardize reporting of advanced CML disease status in those program contexts. Nationally, a discrete HCPCS code for this disease state supports consistent documentation, program evaluation, and potential payment policy alignment for demonstration activities addressing complex oncology care.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical intent of the code, the service settings where it is most likely to apply, and the payer landscape covered. The publication also outlines expected content areas such as benchmark considerations for reporting, relevant policy and program context tied to Medicare demonstration projects, and clinical context for interpreting a blast-phase, nonremission classification in Philadelphia chromosome/BCR-ABL–positive CML. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G9125 describes an oncology disease status designation for chronic myelogenous leukemia that is limited to Philadelphia chromosome positive and/or BCR-ABL positive disease and specifies blast phase not in hematologic, cytogenetic, or molecular remission. The code is intended for use in the context of a Medicare-approved demonstration project.
Service Type: Oncology disease status assessment and reporting
Typical Site of Service: Oncology clinic, hospital outpatient department, or other oncology care settings participating in demonstration projects
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a documented history of Philadelphia chromosome–positive chronic myelogenous leukemia (CML) presents to an oncology clinic enrolled in a Medicare-approved demonstration project. The patient is in blast phase and has persistent disease activity documented by hematologic parameters, cytogenetic testing, or quantitative BCR-ABL molecular testing that demonstrates the patient is not in remission. The oncology nurse schedules a clinic visit for disease-status assessment during which the hematologist/oncologist reviews recent complete blood count (CBC) results, peripheral smear, bone marrow aspirate/biopsy pathology (if performed), cytogenetic/FISH results for t(9;22), and quantitative PCR for BCR-ABL transcript levels. The clinician documents active blast-phase disease and discusses current disease status, prior therapies (e.g., tyrosine kinase inhibitors), and next steps which may include therapy adjustment, referral for hematopoietic stem cell transplant evaluation, additional diagnostic testing, or enrollment procedures related to the demonstration project. Billing for the disease-status assessment uses HCPCS Level II code G9125 to indicate oncology disease status for chronic myelogenous leukemia, Philadelphia chromosome–positive and/or BCR-ABL–positive, blast phase not in hematologic, cytogenetic, or molecular remission, within the Medicare demonstration project framework. Typical site of service is an outpatient oncology clinic or hospital outpatient department where disease-status evaluation and documentation are performed.
Coding Specifications
| Modifier | Description | When to Use |
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