Summary & Overview
HCPCS G9294: Pathology Report Documenting Thickness, Ulceration, and Mitotic Rate
HCPCS Level II code G9294 identifies a pathology report that documents the patient category and provides explicit statements on tumor thickness and ulceration, with mitotic rate included for pT1 lesions. This reporting element is clinically significant because thickness, ulceration, and mitotic rate are key pathologic features used in cancer staging and guide prognostic assessment and downstream clinical decision-making nationally. Accurate, standardized pathology reporting supports consistent staging, treatment planning, registry reporting, and quality measurement.
Key payers commonly covering pathology services in national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical context, typical sites of service, and the types of documentation required to justify the report content. The publication summarizes common modifiers and operational considerations relevant to billing and claims submission, highlights where data are not available in the input, and provides context on how this code aligns with pathology workflow and reporting standards. The content is written for a national audience and is focused on the code’s definition, clinical relevance, and practical implications for medical billing and pathology reporting.
Billing Code Overview
HCPCS Level II code G9294 describes a pathology report that includes the patient category and a clear statement on tumor thickness and ulceration, and, for pT1 lesions, a statement on mitotic rate. This code applies to pathology reporting for cutaneous malignant lesions where thickness, ulceration, and mitotic activity are relevant to staging and prognosis.
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Service type: Pathology report, surgical pathology / dermatopathology interpretation
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Typical site of service: Hospital pathology department, independent pathology laboratory, or outpatient surgical pathology service
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult referred to dermatopathology after surgical excision or biopsy of a suspicious pigmented skin lesion. The clinician (dermatologist, general surgeon, or plastic surgeon) submits the specimen with a request for pathologic staging for cutaneous melanoma or evaluation of a lesion suspicious for melanoma. The pathology report documents the patient category (e.g., AJCC stage or pathologic T category), tumor thickness (Breslow depth) and presence or absence of ulceration; for lesions staged as pT1, the report additionally includes the mitotic rate. Tissue is processed in anatomic pathology with histologic sections, special stains and immunohistochemistry as needed. Results are returned to the ordering provider for treatment planning, which may include wide local excision, sentinel lymph node biopsy, or oncologic referral. Typical site of service is hospital outpatient pathology laboratory or independent anatomic pathology laboratory associated with ambulatory surgical centers or dermatology clinics.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When the pathology complexity or time substantially exceeds usual and documentation supports increased work |
23 |