Summary & Overview
HCPCS G9620: No Uterine Malignancy Screening or Endometrial Sampling
HCPCS Level II code G9620 denotes cases where a patient was not screened for uterine malignancy or did not receive ultrasound and/or endometrial sampling, with no documented reason. This code captures a gap in diagnostic evaluation for potential endometrial cancer and is used in outpatient and ambulatory gynecologic or primary care settings. Nationally, such codes matter because they document missed or deferred diagnostic actions that can affect quality measurement, reporting, and care continuity.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find context on the clinical meaning of the code, common settings where it is applied, and the role it plays in quality documentation and claims processing. The publication outlines benchmarks and coding considerations where available, highlights policy and documentation implications for payers and providers, and summarizes the clinical context around endometrial evaluation when screening or diagnostic steps are omitted.
Data not available in the input for associated taxonomies, specific ICD-10 pairings, and related procedure codes. The content focuses on national implications, coding interpretation, and what information is captured by HCPCS Level II code G9620.
Billing Code Overview
HCPCS Level II code G9620 indicates a patient who was not screened for uterine malignancy or who has not undergone an ultrasound and/or endometrial sampling of any kind, with no reason provided in the record. The service type implied by this description is diagnostic evaluation omission related to gynecologic care, specifically the absence of recommended diagnostic procedures to evaluate the endometrium for malignancy. The typical site of service for encounters coded with G9620 is outpatient ambulatory settings, including gynecology clinics, women's health centers, and primary care offices where initial evaluation and screening decisions occur. If additional diagnostic procedures were later performed, separate procedure or evaluation codes would apply.
Clinical & Coding Specifications
Clinical Context
A 58-year-old woman presents to a gynecology clinic with abnormal uterine bleeding and a new onset of postmenopausal spotting. The clinician documents that evaluation for uterine malignancy was not completed during the visit — no transvaginal ultrasound was obtained and no endometrial sampling (biopsy or curettage) was performed, and no reason for omission was recorded. Typical workflow begins with history and pelvic exam, triage for imaging and endometrial sampling when indicated, scheduling of outpatient transvaginal ultrasound or office endometrial biopsy, and documentation of findings and rationale for any deferred testing. This billing code G9620 is used to indicate that a recommended screen for uterine malignancy was not performed and no reason was provided in the medical record. Typical sites of service include outpatient gynecology clinics, primary care offices, and ambulatory surgical centers where such evaluations would ordinarily be ordered. Common modifiers that may accompany the encounter reflect unusual circumstances, professional/technical components, or patient-related factors (for example 23 for unusual anesthesia or 52 for reduced services). Payors commonly involved in adjudicating claims for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
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