If you’re looking to find the correct HCPCS codes for oncology treatments, you’ve come to the right place. This guide will help you bill accurately for all of your oncology-related operations.
What is oncology, in simple words?
Oncology research and treatment focus on cancer, a disease characterized by the uncontrolled growth of cells that are abnormal. Oncologists are medical professionals whose exclusive emphasis is the treatment of cancer. Treatments include chemotherapy, radiation, and surgery. Since cancer is the second-leading cause of mortality worldwide, investigating it is vital to medicine.
What are the oncology HCPCS codes?
HCPCS codes are used in oncology to categorize and charge for goods and services connected to the management of cancer. Additionally, these codes may cover chemotherapy, radiation therapy, oncologist consultations, and diagnostic testing. They help providers get paid and insurance get invoiced correctly for their members’ treatment.
HCPCS codes – Oncology
- G4019: Oncology/Hematology MIPS specialty set:
Under the MIPS (Merit-based Incentive Payment System) program, this code denotes a particular collection of metrics and activities for reporting quality performance in the oncology and hematology specialties.
- G4031: Radiation Oncology MIPS Specialty Set:
This code refers to a specific set of measures and activities for reporting quality performance in the radiation oncology specialty under the MIPS program.
- G9050: Oncology’s primary focus of visit work-up, evaluation, or staging at the time of cancer diagnosis or recurrence:
This code applies to particular Medicare-approved demonstration projects and indicates that the major goal of the visit is to do a work-up, assessment, or staging during the initial diagnosis or recurrence of cancer.
- G9052: Completed definitive cancer-directed therapy and currently lacks evidence of recurrent disease:
It suggests that the visit’s main goal is to check for disease recurrence in a patient who has finished cancer-directed treatment and shows no evidence of recurrence.
- G9053 – Oncology primary focus of visit expectant management of patient with evidence of cancer for whom no cancer directed therapy is being administered:
This code indicates that the main goal of the visit is to offer expectant care for a patient who has cancer evidence but is not receiving any cancer-directed therapy.
- G9054 – Oncology primary focus of visit supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment:
It indicates that the main goal of the visit is to oversee, coordinate, or manage the care of a patient who has terminal cancer or for whom other medical problems prevent further cancer treatment.
- G9055: Oncology primary focus of visit; other, unspecified service not otherwise listed (for use in a Medicare-approved demonstration project):
In specific Medicare-approved demonstration programs, this number is used to indicate further undefined oncology treatments provided during a visit.
- G9056–GG9060: Oncology practice guidelines management adheres to and differs from guidelines (for use in a Medicare-approved demonstration project):
These codes represent the adherence to and deviations from oncology practice recommendations used in a Medicare-approved demonstration project.
- G9061: Oncology practice guidelines: patient’s condition not addressed by available guidelines (for Medicare-approved demonstration project):
When a patient’s condition in an oncology practice isn’t covered by current standards in a Medicare-approved demonstration study, this code is used.
- G9063–GG9065: Oncology disease status limited to non-small cell lung cancer extent of disease initially established as Stage I, II, or III:
These codes only apply to non-small cell lung cancer that is in one of three stages (I, II, or III).
- G9069 – Oncology disease status small cell lung cancer, limited to small cell and combined small cell/non-small cell extensive Stage at diagnosis:
Small-cell lung cancer is the subject of this code, which focuses on instances that are in advanced stages, metastatic, locally recurrent, or progressing in a demonstration study authorized by Medicare.
- G9071–GG9075: Oncology disease status: invasive female breast cancer (does not include ductal carcinoma in situ) adenocarcinoma as predominant cell type:
These codes describe the stage of invasive female breast cancer, which has distinct features and no signs of progressing.
- G9077–GG9083: Oncology; disease status; prostate cancer, limited to adenocarcinoma as the predominant cell type:
These codes only describe certain stages and characteristics of prostate cancer; there is no indication that the condition is getting worse.
- G9084–GG9089: Oncology; disease status; colon cancer, limited to invasive cancer; adenocarcinoma as predominant cell type:
The colon cancer disease state is represented by these codes, which are confined to certain stages and features without any indication of disease progression.
- G9090–G9095: Oncology; disease status; rectal cancer, limited to invasive cancer:
These codes only describe rectal cancer in terms of its distinct phases and characteristics; there is no indication that the condition is getting worse.
- G9096–GG9099: Oncology; disease status; esophageal cancer, limited to adenocarcinoma or squamous cell carcinoma as the predominant cell type:
These codes describe the esophageal cancer disease state, which is restricted to particular stages and cell types without any indication of disease progression.
Other Important HCPCS codes for oncology procedures
- G9105–G9108:
These codes indicate the pancreatic cancer oncology disease state.
- G9109–GG9112:
These codes represent the oncology disease status for head and neck cancer.
- G9113–GG9117:
These codes represent the disease status for ovarian cancer, limited to epithelial cancer pathologic Stage IA–B (Grade 1) without evidence.
- G9123–GG9126:
These codes, confined to Philadelphia chromosome positive and/or BCR-ABL, reflect the chronic myelogenous leukemia disease status.
- G9128-G9129:
These codes represent the disease state for multiple myeloma, a systemic illness that is smoldering.
- G9133:
This code denotes the prostate cancer disease status, specifically M1 (adenocarcinoma hormone-responsive clinical metastases).
- G9134:
This code indicates the non-Hodgkin’s lymphoma oncology disease state, any cellular categorization Stage I, II, III, or IV at diagnosis, not relapsed.
- G9139:
This code denotes the chronic myelogenous leukemia disease status, which is restricted to Philadelphia chromosome positive and/or BCR-ABL BCR-ABL positive; the severity of the illness is uncertain; staging is ongoing; not listed.
- M0010:
This code denotes the enhancing oncology model (EOM) enhanced services. monthly enhanced oncology services (MEOS) payment.
End Note
The medical billing process for oncology procedures heavily relies on HCPCS codes. To give cancer patients the best treatment possible, it is crucial to keep abreast of the most recent changes to HCPCS codes and other billing requirements.