Summary & Overview
HCPCS G9828: Her2-Targeted Therapy, Initial Course of Treatment
HCPCS Level II code G9828 denotes the administration of Her2-targeted therapies during a patient’s initial course of treatment. This code captures the provision of targeted oncologic treatment for Her2-positive disease and is relevant across outpatient infusion centers and hospital outpatient departments. Nationally, accurate coding of initial Her2-targeted therapy supports treatment tracking, quality measurement, and appropriate payment for high-cost biologic and targeted agents.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The report outlines payer coverage patterns, reimbursement benchmarks, and clinical context for use of Her2-targeted agents during initial therapy.
Readers will learn what G9828 represents clinically and operationally, how major payers approach coverage and payment for initial Her2-targeted therapy, and the implications for billing and revenue cycle workflows. The summary also highlights available benchmarks, notable policy updates affecting coverage, and clinical considerations relevant to initial administration of Her2-targeted treatments. Data not available in the input for associated taxonomies, ICD-10 codes, and related service line details.
Billing Code Overview
HCPCS Level II code G9828 represents Her2-targeted therapies administered during the initial course of treatment. This service involves the delivery of targeted oncologic drug therapy directed at human epidermal growth factor receptor 2 (Her2) as part of the patient’s initial treatment regimen for Her2-positive malignancies.
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Service type: Infusion/Administration of targeted oncology therapy
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Typical site of service: Outpatient infusion center or hospital outpatient department
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A typical patient is a woman diagnosed with HER2-positive invasive breast cancer who presents for initial systemic therapy following diagnostic biopsy and staging. The oncology clinic schedules an infusion visit in the outpatient infusion center or hospital outpatient department to administer HER2-targeted therapy (for example, trastuzumab or pertuzumab) as part of the initial course of treatment. The clinical workflow includes a chemotherapy order reviewed by the oncologist, pre‑infusion nursing assessment (vital signs, weight, review of prior cardiac function), verification of HER2 status documented in the medical record, infusion pump setup, administration of the targeted agent per protocol, observation for infusion reactions, and documentation of lot numbers, dose, and infusion start/stop times. Typical site of service is an outpatient infusion center or hospital outpatient department. Common payors for coverage adjudication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA plans, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required to administer therapy is substantially greater than usual (e.g., complex dosing adjustments, prolonged monitoring beyond standard protocol). |
23 |