Summary & Overview

HCPCS G9678: Oncology Care Model Monthly Enhanced Oncology Services

HCPCS Level II code G9678 represents the Oncology Care Model (OCM) monthly payment for Enhanced Oncology Services (MEOS) provided to OCM beneficiaries. The code designates a bundled monthly payment mechanism to OCM-participating practitioners for OCM-defined enhanced services that support care coordination, management, and patient-centered oncology care. Nationally, G9678 matters because it aligns oncology practices with value-based care goals and structures payments for non-procedural, longitudinal services that are not captured in traditional fee-for-service codes.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical context and service setting, comparisons of payer coverage approaches where available, and guidance on what components the code is intended to support under the OCM framework. The publication outlines benchmark considerations, relevant policy context for OCM payments, and operational implications for oncology practices participating in OCM. Data not available in the input will be explicitly noted in the specific sections where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareG9678HCPCS Level IIOncology Care ModelEnhanced Oncology ServicesCare CoordinationOncology OutpatientValue-Based CareMonthly Care Payment

Billing Code Overview

HCPCS Level II code G9678 describes a monthly enhanced oncology services payment under the Oncology Care Model (OCM). The code applies to payments made to OCM practitioners for the provision of OCM-defined enhanced services to OCM beneficiaries. These enhanced services are components of the OCM participation agreement that support coordinated, patient-centered oncology care.

Service type: Enhanced oncology care coordination and management services as defined by the Oncology Care Model
Typical site of service: Oncology outpatient clinics and practice settings participating in the Oncology Care Model

Clinical & Coding Specifications

Clinical Context

A 63-year-old patient with newly diagnosed stage III colorectal adenocarcinoma is enrolled in a practice participating in the Oncology Care Model (OCM). The multispecialty oncology practice bills a monthly enhanced oncology services (MEOS) payment using G9678 for the care coordination and enhanced services furnished to OCM beneficiaries during a given calendar month. The clinical workflow includes the oncologist and designated care team (nurse navigator, social worker, and pharmacist) conducting comprehensive treatment planning, documenting a 13-element care plan, performing medication reconciliation, arranging timely access to systemic therapy, coordinating symptom management and palliative care referrals, and providing 24/7 access to clinicians for acute issues. The practice documents these enhanced services in the patient’s medical record and bills G9678 monthly to reflect the OCM MEOS payment for the enhanced services provided to the OCM beneficiary during that month. Typical sites of service include outpatient oncology clinics, infusion centers, and associated practice locations where care coordination and monthly enhanced services are delivered.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	When additional work beyond the usual is documented for an associated service; rarely used with MEOS but may apply to separately billed procedures.
`52`	Reduced services	When a separately billed service associated with oncology care is partially reduced or not completed.
`53`	Discontinued procedure	When a separately billed procedure is started but discontinued; not applied to the monthly MEOS payment itself.
`54`	Surgical care only	When the billing practitioner provided only surgical care portion; relevant to surgeons in multidisciplinary oncology care.
`55`	Postoperative management only	When the practitioner provides only postoperative care in the global period.
`56`	Preoperative management only	When the practitioner provides only preoperative care.
`62`	Two surgeons	When two surgeons share a procedure; applicable to surgical oncology procedures occurring in the OCM population.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery	When an advanced practitioner serves as an assistant at surgery.
`CQ`	Telehealth originating site facility not reimbursed under telecommunications rules	When telehealth originates from a facility under specific payer rules; may be used for telehealth encounters supporting MEOS.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals	Relevant when anesthesia services are part of cancer surgeries for OCM beneficiaries.

Taxonomy Code	Specialty	Notes
`208000000X`	Hematology/Oncology	Medical oncologists who lead systemic therapy and OCM participation.
`207RC0000X`	Radiation Oncology	Radiation oncologists coordinating radiotherapy within the OCM care plan.
`207P00000X`	Surgical Oncology	Surgeons performing cancer-directed operative procedures and participating in care coordination.
`361A00000X`	Nurse Practitioner	Advanced practice providers who deliver care coordination, symptom management, and patient education.
`163W00000X`	Registered Nurse	Nurse navigators and clinical nurses who manage navigation, symptom triage, and care plan documentation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C18.7`	Malignant neoplasm of sigmoid colon	Representative colorectal cancer diagnosis for patients receiving systemic therapy and OCM-enhanced services.
`C50.912`	Malignant neoplasm of unspecified site of right female breast	Breast cancer diagnosis commonly managed with systemic therapy and multidisciplinary care under OCM.
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Lung cancer diagnosis frequently requiring complex coordination of systemic and supportive care.
`C61`	Malignant neoplasm of prostate	Prostate cancer patients receiving oncology-directed therapies and care management.
`C77.0`	Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck	Common metastatic diagnosis relevant to treatment planning and symptom management within OCM.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hour	Commonly billed for first hour of chemotherapy infusions delivered in the outpatient infusion center; occurs concurrently with MEOS support.
`96413`	Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for primary infusion)`	Billed for prolonged infusion time for chemotherapeutic agents; complements the monthly MEOS services for treatment delivery.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Used for intermediate-level outpatient visits for symptom assessment and management that support OCM enhanced services.
`99497`	Advance care planning including the explanation and discussion of advance directives, first 30 minutes	Performed when ACP discussions are part of the comprehensive care plan furnished to OCM beneficiaries and documented alongside MEOS activities.
`G0491`	Services provided to beneficiaries in a reciprocal telephone/telehealth management program (care coordination)	Telehealth or care coordination services that may support the enhanced services described by the OCM MEOS payment.