HCPCS G9428: Pathology Report for Invasive Tumor Histologic Features - OpenPayer

Summary & Overview

HCPCS G9428: Pathology Report for Invasive Tumor Histologic Features

HCPCS Level II code G9428 denotes a detailed pathology report for invasive tumors that documents patient category, tumor thickness, ulceration, mitotic rate, peripheral and deep margin status, and microsatellitosis. These elements are critical for staging, prognosis, and downstream treatment planning for malignant skin and soft-tissue lesions. Nationally, standardized reporting of these features supports consistent clinical decision-making and aligns pathology documentation with oncology and surgical care pathways. Key payers in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context and common sites of service tied to G9428, a summary of how major payers commonly categorize and reimburse pathology reporting services, and benchmarks for typical utilization patterns where available. The publication also highlights documentation components tied to G9428 to help organizations align pathology reports with payer expectations and clinical staging needs. Data not available in the input is noted where payer-specific rate tables, ICD-10 pairings, or associated taxonomies would normally appear.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9428HCPCS Level IIpathologysurgical pathologytumor staginghistopathologymargin statusmicrosatellitosis

Billing Code Overview

HCPCS Level II code G9428 describes a pathology report for invasive tumors that includes the patient category, tumor thickness, presence of ulceration and mitotic rate, peripheral and deep margin status, and presence or absence of microsatellitosis. This reporting item is specific to surgical pathology evaluation of invasive cutaneous or soft-tissue tumors where those histopathologic features are essential for prognostic assessment and staging.

Service type: Pathology surgical specimen evaluation and detailed histopathology reporting
Typical site of service: Hospital pathology laboratory, independent pathology laboratory, or outpatient surgical pathology service

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient presents to dermatology with a suspicious pigmented lesion on the upper back. The lesion is surgically excised by a dermatologic surgeon in an outpatient ambulatory surgery center. The specimen is submitted to pathology with clinical history indicating concern for invasive cutaneous melanoma. The anatomic pathology report documents tumor staging details required for melanoma management: pathological tumor category (pT), tumor thickness (Breslow depth), presence or absence of ulceration, mitotic rate (per mm2), status of peripheral and deep margins, and presence or absence of microsatellitosis. This detailed pathology documentation supports staging, prognosis, multidisciplinary treatment planning (including consideration of sentinel lymph node biopsy and adjuvant therapy), and accurate coding and billing for the pathology service. Typical site of service: outpatient surgery center or hospital outpatient department; service type: surgical pathology report for skin excision with melanoma evaluation.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when the pathology interpretation requires substantially greater work or complexity than usual (e.g., unusually complex immunohistochemical panel or extended consultative effort).
`23`

HCPCS G0122: Colorectal Cancer Screening, Barium Enema

HCPCS-G8784-PATIENT-NOT-ELIGIBLE-SERVICE-EXCEPTION

HCPCS G8784: Patient Not Eligible for Service

HCPCS-G8420-BMI-NORMAL-NO-FOLLOW-UP-REQUIRED

HCPCS G8420: BMI Documented Normal, No Follow-Up Required

HCPCS-G2159-PNEUMOCOCCAL-VACCINE-STATUS-ADVERSE-REACTION-OR-INCOMPLETE-SEQUENCE

HCPCS G2159: Pneumococcal Vaccine Status or Prior Vaccine Reaction

HCPCS-G0176-ACTIVITY-THERAPY-MENTAL-HEALTH-45-MINUTE-SESSION

HCPCS G0176: Activity Therapy for Mental Health, 45+ Minute Session

HCPCS-G0013-PREP-INDIVIDUAL-COUNSELING-HIV-RISK-REDUCTION

HCPCS G0013: Individual PrEP Counseling and HIV Risk Assessment

HCPCS-G0028-MEDICAL-REASON-NOT-SCREENING-TOBACCO-USE

HCPCS G0028: Medical Reason for Not Screening for Tobacco Use

HCPCS-G9308-UNPLANNED-RETURN-TO-OPERATING-ROOM-30-DAY

HCPCS G9308: Unplanned Return to Operating Room for Postoperative Complication

HCPCS-G9667-STATIN-NONUSE-MEDICAL-REASON-DOCUMENTATION

HCPCS G9667: Documentation of Medical Reason for Not Using Statin Therapy

HCPCS-G6006-RADIATION-SINGLE-PORTAL-20MEV-OR-GREATER

HCPCS G6006: Radiation Treatment Delivery, Single Area, ≥20 MeV

Showing 1–10 of 1996

Taxonomy Code	Specialty	Notes
207W00000X	Dermatology	Dermatologists perform skin excisions and submit specimens for pathology.
207L00000X	Pathology	Anatomic and clinical pathologists perform microscopic evaluation and generate the detailed pathology report.
2080P0208X	General Surgery	General or surgical oncologists may perform excisions and coordinate definitive management of melanoma.
2084P0800X	Surgical Oncology	Surgical oncologists perform complex resections and coordinate cancer care; often involved in melanoma cases.
363L00000X	Dermatopathology	Dermatopathologists specialize in skin histopathology and provide detailed melanoma staging elements.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C43.9`	Malignant melanoma of skin, unspecified	Directly relevant for invasive cutaneous melanoma requiring pathologic staging with thickness, ulceration, mitotic rate, margins, and microsatellitosis assessment.
`C43.7`	Malignant melanoma of lower limb, including hip	Melanoma site-specific code; pathology evaluation elements are identical and required for staging and management.
`C43.5`	Malignant melanoma of trunk	Common site for melanoma; pathology report details inform staging and treatment planning.
`D03.9`	Melanoma in situ, unspecified	For non-invasive lesions, pathology still reports margins and presence/absence of invasion; some elements (e.g., mitotic rate) may be less applicable.
`Z85.820`	Personal history of malignant melanoma of skin	Relevant in surveillance and when new lesions are excised; pathology report determines recurrence versus new primary.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`88305`	Level IV surgical pathology, gross and microscopic examination	Common code for evaluation of a single tissue specimen requiring routine microscopic examination; often billed for melanoma excisions when no extensive special studies are required.
`88313`	Immunohistochemistry, each antibody stain	Used when immunohistochemical stains (e.g., S100, SOX10, HMB-45, Melan-A) are performed to aid diagnosis of melanoma; may be reported in addition to primary pathology code.
`88342`	Level IV - surgical pathology, microscopic (consultation and review)	Used when a second pathologist provides a consultative review or complex interpretation is performed; supports complex diagnostic reporting.
`88331`	Consultation and report on referred slides, prepared elsewhere	Used when slides are referred to another laboratory for additional review or opinion.
`88311`	Decalcification service requested, when performed	Rarely used for skin but may apply if specimen includes bone or hard tissue requiring decalcification prior to melanoma margin assessment.

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