Summary & Overview
HCPCS G9547: Imaging Characterization of Likely Benign Renal and Adrenal Lesions
HCPCS Level II code G9547 documents imaging-based characterization of likely benign cystic renal lesions (Bosniak I or II) and small adrenal lesions meeting specific size criteria on unenhanced CT, washout CT, or MRI with in- and opposed-phase sequences. This code captures the imaging determination that a lesion is likely benign based on standardized appearance and institutional protocols, supporting appropriate clinical management and follow-up decisions.
The analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for G9547, how it aligns with imaging protocols used to distinguish benign versus suspicious lesions, and what elements are typically documented in the imaging report.
The publication also presents benchmarking and payment considerations, typical sites of service, and practical coding context for radiology service lines. Policy and payer coverage summaries highlight where documentation and imaging technique influence recognition of the finding. Clinical context reviews the Bosniak classification for cystic renal lesions and size-based criteria used for adrenal lesions when labeled likely benign by unenhanced CT, washout CT, or MRI with in- and opposed-phase sequences.
Data not available in the input for associated taxonomies, specific ICD-10 mappings, and related procedure codes are noted where relevant.
Billing Code Overview
HCPCS Level II code G9547 describes imaging findings consistent with a simple-appearing cystic renal lesion (Bosniak I or II), or an adrenal lesion ≤ 1.0 cm, or an adrenal lesion > 1.0 cm and ≤ 4.0 cm when classified as likely benign by imaging. The specified imaging modalities referenced in the description include unenhanced CT, washout-protocol CT, or MRI with in- and opposed-phase sequences, or other equivalent institutional imaging protocols.
Service type: Imaging-based lesion characterization and surveillance
Typical site of service: Radiology departments and outpatient imaging centers, including hospital-based radiology suites where CT or MRI studies are performed.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents after an incidental finding of a small renal cyst on abdominal imaging performed for unrelated reasons. Cross-sectional imaging with an unenhanced CT and/or CT washout protocol demonstrates a simple-appearing cyst consistent with Bosniak I–II morphology, without suspicious enhancement. Alternatively, a 2.8 cm adrenal lesion is identified on a non-contrast CT, and dedicated adrenal protocol imaging including delayed contrast washout or MRI with in- and opposed-phase sequences classifies the lesion as likely benign. The clinical workflow includes: initial detection on abdominal or chest imaging, targeted dedicated imaging (unenhanced CT, CT washout protocol, or MRI chemical shift), radiology interpretation documenting Bosniak classification or adrenal lesion characterization with size and attenuation/washout numbers, and communication of surveillance or no-treatment recommendations to the referring clinician. Typical site of service is the hospital radiology department or an outpatient imaging center with CT and MRI capabilities. Common presenting scenarios include incidental renal or adrenal masses found during evaluation for flank pain, hematuria, abdominal pain, or during staging/surveillance imaging for unrelated malignancy.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when documentation supports substantially greater effort or complexity for imaging interpretation/reporting beyond typical for lesion characterization. |