2025 HCPCS code G9054

Supervising, coordinating, or managing care of a patient with terminal cancer or for whom other medical illness prevents further cancer treatment.

This code should be used in conjunction with other CPT codes to fully describe the patient's visit. This code is only applicable to providers participating in the Medicare-approved demonstration project. Additional G codes may be required to report the primary purpose of the visit, disease status, and adherence to practice guidelines.

Medical necessity is established by the patient's terminal cancer diagnosis or other serious illness preventing further cancer treatment and the need for symptom management, end-of-life care planning, or palliative therapies.This code is part of a Medicare-approved demonstration project and may have specific coverage requirements.

The provider coordinates or explains the supervision, coordination, or management of care for a patient with terminal cancer or a patient whose other conditions prevent further cancer treatment. This service also includes symptom management, end-of-life care planning, and management of palliative therapies.Only providers who are specialists in hematology and oncology can participate in this demonstration project. The project applies only to Medicare patients who are not enrolled in a Medicare Advantage plan.

In simple words: This code is used for visits where the main focus is on managing the care of a patient with terminal cancer or other serious illnesses that prevent further cancer treatment. It includes managing symptoms, planning end-of-life care, and palliative therapies.

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; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a Medicare-approved demonstration project).

Example 1: A patient with terminal lung cancer is experiencing severe pain and shortness of breath. The oncologist coordinates palliative care services, including pain management and oxygen therapy, to improve the patient's quality of life., A patient with advanced heart failure also has a diagnosis of breast cancer, but further cancer treatment is not possible due to the heart condition. The oncologist supervises the patient's care, focusing on symptom management and end-of-life care planning., A patient with terminal colon cancer is admitted to hospice care. The oncologist coordinates the patient's care with the hospice team, focusing on pain management and emotional support.

Documentation should support the patient's terminal cancer diagnosis, the reason further cancer treatment is not possible, the focus of the visit on supervising, coordinating, or managing care, and the specific services provided, including symptom management, end-of-life care planning, and palliative therapies.

** This code is part of a Medicare-approved demonstration project which began in 2006. It is intended for use by hematologists and oncologists providing care to Medicare patients who are not enrolled in a Medicare Advantage plan.The demonstration project requires reporting this code along with CPT® codes for the primary focus of the patient’s visit, the status of the disease, and the adherence to practice guidelines.

  • Payment Status: Active
  • Specialties:Hematology, Oncology, Palliative Care
  • Place of Service:Office, Inpatient Hospital, Hospice, Home
** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.