G9283 NSCLC Histology — HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS G9283: NSCLC Biopsy and Cytology Histologic Classification

HCPCS Level II code G9283 is used for pathology and cytology reports that classify non small cell lung cancer (NSCLC) biopsy or cytology specimens into a specified histologic subtype or designate the specimen as NSCLC-not otherwise specified with an explanation. Accurate histologic classification guides targeted therapy selection and impacts clinical decision-making and reporting. Nationally, standardized pathology documentation supports appropriate cancer care pathways and downstream billing, quality reporting, and registry submissions.

Key payers considered in this profile include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The summary covers where this service is typically performed (hospital and independent pathology laboratories and cancer centers) and the clinical role of histologic classification in NSCLC management.

Readers will find benchmarks for billing recognition and common payer coverage patterns, high-level policy and reimbursement considerations, and clinical context explaining why explicit histologic classification or documented NSCLC-NOS with explanation matters for oncologic workflows and treatment planning. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9283HCPCS Level IIpathologynon small cell lung cancerNSCLCbiopsycytologyhistologic classificationoncology

Billing Code Overview

HCPCS Level II code G9283 documents a pathology report for non small cell lung cancer (NSCLC) biopsy and cytology specimens that classifies the tumor into a specific histologic type or as NSCLC-not otherwise specified (NSCLC-NOS) with an explanatory comment. This code represents reporting of diagnostic pathology findings that clarify histologic subtype for lung cancer cases.

Service Type: Pathology and diagnostic reporting for oncologic specimens

Typical Site of Service: Hospital pathology laboratory, independent pathology laboratory, or specialized cancer center diagnostic laboratory

Clinical & Coding Specifications

Clinical Context

A 67-year-old current or former smoker presents with a persistent peripheral lung mass identified on chest CT and PET-CT. The pulmonologist performs a CT-guided core needle biopsy of the lung lesion or a bronchoscopic/transbronchial biopsy, with specimens sent to surgical pathology and cytology. Pathology performs histologic evaluation and ancillary studies (immunohistochemistry and, if indicated, molecular testing) and documents that the tumor is a non–small cell lung carcinoma classified to a specific histologic type (for example, adenocarcinoma, squamous cell carcinoma, large cell carcinoma) or designated as NSCLC-NOS with an explanatory comment when features are insufficient for a more specific designation. The pathology report includes specimen source, adequacy, microscopic description, final classification, and comments regarding limitations of small samples and recommended additional testing (e.g., molecular profiling) to guide targeted therapy decisions. Typical workflow participants include the ordering pulmonologist or thoracic surgeon, interventional radiology when image guidance is used, surgical pathology/cytology staff, and the treating medical oncologist for staging and treatment planning. Typical sites of service are hospital outpatient departments, ambulatory surgical centers, or interventional radiology suites where percutaneous or endoscopic biopsy procedures are performed.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

HCPCS G9899: Mammography Results Documented and Reviewed

HCPCS-G9266-MAINTENANCE-HEMODIALYSIS-NO-CATHETER-90-DAYS

HCPCS G9266: Maintenance Hemodialysis ≥90 Days Without Catheter

HCPCS-G8566-NOT-ELIGIBLE-REFERRAL-OTOLOGIC-EVALUATION-SUDDEN-HEARING-LOSS

HCPCS G8566: Not Eligible for Otologic Evaluation Referral Measure

HCPCS-G9403-POST-DISCHARGE-FOLLOW-UP-NOT-COMPLETED

HCPCS G9403: Clinician-documented Reason for Missed 30-day Follow-Up

HCPCS-G9233-TOTAL-KNEE-REPLACEMENT-QUALITY-ACTIONS-COMPLETE

HCPCS G9233: Completion of Total Knee Replacement Quality Measures

HCPCS-G0920-TYPE-ANATOMIC-LOCATION-ACTIVITY-DOCUMENTED

HCPCS G0920: Type, Anatomic Location, and Activity Documented

HCPCS-G0509-TELEHEALTH-CRITICAL-CARE-CONSULTATION-SUBSEQUENT

HCPCS G0509: Telehealth Critical Care Consultation, Subsequent

HCPCS-G8923-LEFT-VENTRICULAR-EJECTION-FRACTION-LE-40

HCPCS G8923: Left Ventricular Ejection Fraction ≤ 40% or Depressed Systolic Function

HCPCS-G9713-HOSPICE-UTILIZATION-DURING-MEASUREMENT-PERIOD

HCPCS G9713: Patients Using Hospice Services During Measurement Period

HCPCS-G9292-DOCUMENTATION-MEDICAL-REASON-NOT-REPORTING-PATIENT-CATEGORY

HCPCS G9292: Documentation of Medical Reason for Not Reporting Patient Category

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
207RP1000X	Pulmonary Disease	Pulmonologists commonly perform bronchoscopic or transbronchial biopsies and order pathology.
2080P0208X	Thoracic Surgery	Thoracic surgeons perform surgical lung biopsies and coordinate specimen submission.
2084P0800X	Diagnostic Radiology	Interventional radiologists commonly perform CT-guided percutaneous lung biopsies.
2085R0202X	Pathology	Pathologists and cytopathologists provide the histologic classification and reporting.
208D00000X	Medical Oncology	Medical oncologists request diagnostic classification to plan systemic therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Primary diagnosis for a suspected lung cancer mass requiring biopsy and histologic classification.
`C34.1`	Malignant neoplasm of upper lobe, bronchus or lung	Localizes the lesion site and supports justification for targeted biopsy.
`C34.31`	Malignant neoplasm of right upper lobe, bronchus or lung	Site-specific code used when lesion laterality and lobe are documented for procedural coding.
`C34.32`	Malignant neoplasm of left upper lobe, bronchus or lung	As above, for left-sided upper lobe lesions.
`R91.8`	Other nonspecific abnormal finding of lung field	Often used when a radiographic abnormality prompts biopsy prior to definitive malignant diagnosis.
`Z85.118`	Personal history of other malignant neoplasm of bronchus and lung	May appear in history when assessing recurrence or prior lung cancer during diagnostic workup.
`J98.4`	Other disorders of lung, not elsewhere classified	Used when documenting non-specific pulmonary symptoms or conditions prompting diagnostic biopsy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`32405`	Biopsy, lung, percutaneous needle; single lesion	CT- or ultrasound-guided percutaneous core needle biopsy often performed to obtain tissue that pathology classifies as NSCLC or NSCLC-NOS.
`31628`	Bronchoscopy, flexible, transbronchial lung biopsy(s), single lobe	Used when tissue is obtained bronchoscopically for cytology and histology classification.
`32505`	Thoracoscopy, surgical; with diagnostic biopsy(s) of lung or pleura	Surgical thoracoscopic biopsies provide larger specimens for definitive histologic typing when less invasive methods are non-diagnostic.
`88342`	Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain	Common ancillary test added to H&E that helps subtype NSCLC (e.g., TTF-1, p40) and supports the pathology classification.
`88360`	Morphologic examination and interpretation, gross and microscopic, surgical pathology, with simple special stains	Represents basic pathology processing and reporting of biopsy specimens with final histologic diagnosis.

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