Summary & Overview
HCPCS G9135: Non-Hodgkin's Lymphoma Disease Status, Stage III–IV
HCPCS Level II code G9135 designates documentation and reporting of disease status for Non-Hodgkin's lymphoma at advanced stages (III or IV) when the disease is neither relapsed nor refractory. The code is specific to a Medicare-approved demonstration project and captures clinical staging information critical for program evaluation and care coordination. Nationally, accurate use of this code supports epidemiologic tracking, quality measurement in oncology programs, and coherent reporting across outpatient oncology sites.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The discussion addresses how G9135 fits into oncology reporting workflows, typical sites of service such as outpatient oncology clinics and hospital outpatient departments, and the clinical context for advanced Non-Hodgkin's lymphoma staging.
Readers will find an overview of the code's clinical definition, the settings where it is most likely used, and what to expect in payer coverage considerations at a high level. The publication also summarizes available benchmarks and policy-relevant points for national programs and demonstration projects. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code G9135 denotes oncology disease status reporting for Non-Hodgkin's lymphoma, any cellular classification, stage III or IV, not relapsed and not refractory, intended for use in a Medicare-approved demonstration project.
Service Type: Oncology — disease status assessment/reporting
Typical Site of Service: Outpatient oncology clinic or hospital outpatient department, where disease staging and status assessments for advanced Non-Hodgkin's lymphoma are documented and reported for demonstration or programmatic purposes.
Clinical & Coding Specifications
Clinical Context
A 68-year-old Medicare beneficiary with newly diagnosed non-Hodgkin's lymphoma (nodal or extranodal) presents for initial evaluation and staging after diagnostic biopsy. Imaging (CT/PET) and bone marrow biopsy confirm advanced disease consistent with Stage III–IV by Ann Arbor criteria. The patient is not relapsed and not refractory and is being assessed as part of a Medicare-approved demonstration project for disease-status reporting. Clinical workflow: outpatient oncology clinic visit for disease-status documentation; review of pathology and imaging; assignment of stage (III or IV) and documentation of absence of relapse or refractory disease; multidisciplinary team discussion including medical oncology, radiation oncology as needed, and case management for treatment planning; completion of required demonstration-project forms and submission of the G9135 code for disease-status reporting to the demonstration payer.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when additional work or complexity beyond typical reporting of disease status requires significantly more resources or time to document staging details. |
23 |