Summary & Overview
HCPCS G9126: CML Remission Status, Philadelphia/BCR-ABL Positive
HCPCS Level II code G9126 designates disease status for patients with chronic myelogenous leukemia (CML) who are Philadelphia chromosome positive and/or BCR-ABL positive and are in hematologic, cytogenetic, or molecular remission. The code is limited to use within a Medicare-approved demonstration project and captures a clinical remission designation rather than a discrete procedure or therapy. Nationally, clear coding for remission status supports programmatic demonstration tracking, outcomes measurement, and appropriate documentation in oncology care.
Key payers relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical meaning of the code, the service type and typical sites of service where this designation is documented, and which payers are commonly involved in coverage discussions. The publication summarizes how the code is positioned within oncology disease-status reporting, notes that it is tied to demonstration project use, and identifies gaps where input data were not provided.
This summary is intended to inform billing managers, oncology clinicians, and policy analysts about the code's clinical purpose, the payer landscape for national considerations, and the types of documentation and service settings associated with G9126. Data not available in the input are explicitly noted and not inferred.
Billing Code Overview
HCPCS Level II code G9126 describes an oncology status designation for chronic myelogenous leukemia (CML) cases that are Philadelphia chromosome positive and/or BCR-ABL positive and are documented as being in hematologic, cytogenetic, or molecular remission. The code is specified for use in a Medicare-approved demonstration project.
Service type: Oncology — disease status assessment / remission designation
Typical site of service: Oncology clinic, hospital outpatient department, or other settings where oncology disease-status evaluations are documented as part of a demonstration project
Data not available in the input for payers, associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient with a history of Philadelphia chromosome–positive chronic myelogenous leukemia (CML) presents to a hematology-oncology clinic for routine disease-status assessment as part of a Medicare-approved demonstration project. The patient is receiving chronic oral tyrosine kinase inhibitor therapy and requires periodic monitoring to document hematologic, cytogenetic, and molecular remission. The clinical workflow includes review of interval history and medication tolerance, a focused physical exam, peripheral blood draw for complete blood count and BCR-ABL quantitative PCR, and, if indicated by results, referral for bone marrow cytogenetics or molecular testing. Documentation emphasizes disease status (hematologic, cytogenetic, molecular remission) and linkage to the demonstration project for Medicare reporting. Typical site of service is an outpatient hematology/oncology clinic or hospital outpatient department. Service type is oncology disease-status assessment and monitoring for CML (Philadelphia chromosome–positive/BCR-ABL–positive) within a demonstration project context.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard submission | Use when no special circumstances apply and the service is billed as usual |
22 |