Summary & Overview
HCPCS G9132: Prostate Cancer, Hormone-Refractory with Clinical Metastases
HCPCS Level II code G9132 designates a disease-status category for metastatic, hormone-refractory (androgen-independent) prostate adenocarcinoma, intended for use in a Medicare-approved demonstration project. The code captures a specific clinical population—patients with rising PSA despite anti-androgen therapy or post-orchiectomy and documented clinical metastases—and informs classification and reporting within demonstration settings. Nationally, accurate use of this HCPCS Level II code supports consistency in documenting advanced prostate cancer status across participating programs and facilitates demonstration-specific tracking and evaluation.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for G9132, the expected service type and typical sites of service, and guidance on where to find additional billing and policy resources. The publication summarizes available benchmarks and policy considerations relevant to demonstration projects, outlines common modifiers that may appear on claims, and highlights gaps where input data are not available. Data not available in the input are noted explicitly so readers understand the limits of the summary.
Billing Code Overview
HCPCS Level II code G9132 describes an oncology disease-status classification for prostate cancer, limited to adenocarcinoma that is hormone-refractory/androgen-independent (for example, rising PSA on anti-androgen therapy or post-orchiectomy) with clinical metastases. This code is specified for use in a Medicare-approved demonstration project.
Service type: Oncology disease-status assessment and classification.
Typical site of service: Oncology clinic or hospital outpatient setting, including sites administering disease evaluations for metastatic, hormone-refractory prostate cancer.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 72-year-old man with a history of prostate adenocarcinoma previously treated with orchiectomy and androgen-deprivation therapy presents with rising prostate-specific antigen (PSA) and new bone pain. Cross-sectional imaging and a bone scan demonstrate clinical metastases. The oncology team documents an androgen-independent, hormone-refractory disease course and enrolls the patient in a Medicare-approved demonstration project evaluating outcomes for this disease state. The clinical workflow includes oncology assessment, review of prior treatments (including anti-androgen therapy and orchiectomy), documentation of rising PSA despite hormonal therapy, staging imaging, multidisciplinary discussion, and structured data capture required by the demonstration project for claims submission using the HCPCS Level II code G9132.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when work required is substantially greater than typically required for the service, with documentation of reasons and extra work. |
23 |