2025 HCPCS code G9105
(Deleted) Effective Date: N/A Deletion Date: N/A Oncology - Medicare Demonstration Projects G Codes Feed
Oncology; disease status; pancreatic cancer, limited to adenocarcinoma as predominant cell type; post r0 resection without evidence of disease progression, recurrence, or metastases.
The medical necessity of using G9105 stemmed from its role in the Medicare demonstration project. Use of the code was required for participation in the project to aid data collection and analysis related to pancreatic cancer treatment and outcomes. This project targeted non-Medicare Advantage beneficiaries.
Only physician specialists in hematology and oncology could participate in this demonstration project. The physician was responsible for reporting G9105 alongside relevant CPT® codes to represent the focus of the visit, disease status, and adherence to guidelines. The project applied to Medicare beneficiaries not enrolled in Medicare Advantage plans.
In simple words: This code was used in a special Medicare project to track the status of pancreatic cancer (specifically adenocarcinoma) after surgery where all visible cancer was removed, when there were no signs of the cancer coming back or spreading.
This code was used in a Medicare-approved demonstration project to report the disease status of pancreatic cancer, specifically limited to adenocarcinoma as the predominant cell type, after complete tumor removal (R0 resection) with no evidence of disease progression, recurrence, or spread to other sites (metastases). This demonstration project aimed to assess the impact of collecting structured data elements from providers treating Medicare beneficiaries with specific cancers. The project involved reporting this code with CPT® codes for the primary focus of visit, the disease status, and adherence to practice guidelines.
Example 1: A patient with pancreatic adenocarcinoma undergoes a complete resection (R0) of the tumor. During a follow-up visit, the oncologist uses G9105 in conjunction with other CPT® codes to indicate the patient's post-surgical status as being without evidence of disease progression, recurrence, or metastases., A patient initially diagnosed with pancreatic adenocarcinoma completes R0 surgery. During subsequent surveillance visits, G9105 is used to classify the patient's current disease status., A hematology-oncology specialist tracks data on a cohort of patients post R0 resection for pancreatic adenocarcinoma, using G9105 to classify patients with no detectable recurrence or metastasis.
Documentation should include confirmation of pancreatic adenocarcinoma diagnosis, surgical report confirming R0 resection, and ongoing clinical notes indicating lack of recurrence, progression, or metastases. Additionally, documentation regarding the primary focus of each visit and adherence to treatment guidelines must be maintained.
** This code was specific to a time-limited Medicare demonstration project and is no longer in use. As of today's date (December 10, 2024), G9105 is considered deleted and should not be used for billing. The information provided here is historical and is relevant for understanding past coding practices and the rationale behind the demonstration project.
- Payment Status: Inactive
- Specialties:Hematology, Oncology
- Place of Service:Office