2025 HCPCS code G9073
Effective Date: N/A Medicare Demonstration Projects - Oncology - Current Disease Status Feed
Invasive female breast cancer, predominantly adenocarcinoma, Stage IIIA-IIIB (not T3, N1, M0), ER/PR positive, no progression/recurrence/metastasis, not ductal carcinoma in situ.
Medical necessity is established by the patient's diagnosis of invasive breast cancer and participation in the Medicare demonstration project focusing on specific cancer types and treatment adherence.
Hematologists and oncologists participating in the Medicare demonstration project are responsible for reporting this code along with CPT codes indicating the primary focus of the patient visit, disease status, and adherence to practice guidelines.
In simple words: This code is used in a special Medicare project for tracking breast cancer treatment. It tells the doctor that the patient has a certain type of breast cancer (adenocarcinoma) that is at a certain stage (IIIA-IIIB) and has certain characteristics (ER/PR positive, no spread). It's used to help doctors follow guidelines and track how well treatments are working.
This code reports the disease status of a patient’s invasive female breast cancer for a Medicare-approved demonstration project. The cancer is predominantly adenocarcinoma, Stage IIIA to IIIB, but not categorized as T3, N1, or M0. It is estrogen receptor (ER) positive and/or progesterone receptor (PR) positive. There is no evidence of disease progression, recurrence, or metastasis. It excludes ductal carcinoma in situ.
Example 1: A 60-year-old female patient with invasive breast cancer, confirmed as adenocarcinoma, is staged as IIIB and is ER/PR positive. She is receiving ongoing treatment from a participating oncologist and this code is reported to track her disease status within the demonstration project., A 55-year-old female patient with invasive breast cancer, predominantly adenocarcinoma and staged as IIIA, is ER positive and PR negative. She shows no signs of metastasis and is being treated by a participating oncologist who reports G9073 to monitor her disease progression within the Medicare project guidelines., A 70-year-old female with stage IIIA invasive breast cancer, predominantly adenocarcinoma, tests positive for both ER and PR. She exhibits no evidence of recurrence or metastasis. Her oncologist, part of the Medicare demonstration program, utilizes G9073 for ongoing disease tracking and reporting adherence to clinical guidelines.
Documentation should include pathology reports confirming adenocarcinoma, staging documentation (IIIA-IIIB, not T3, N1, M0), receptor status (ER/PR positive), and clinical notes indicating no evidence of disease progression, recurrence, or metastasis. The patient's enrollment in the Medicare demonstration project should also be documented.
** This code is part of a broader set of HCPCS G codes used in the Medicare demonstration project. Related codes for the primary purpose of visit (G9050-G9055), adherence to practice guidelines (G9056-G9062), and other disease statuses (G9063-G9130) should be used as appropriate.
- Specialties:Hematology, Oncology
- Place of Service:Office