2025 HCPCS code G9055

This HCPCS code reports the primary focus of a cancer patient's visit when another unspecified service is rendered, not listed in other HCPCS codes.It's part of a Medicare demonstration project.

Adhere to the guidelines of the specific Medicare demonstration project in which this code is used.The code should only be utilized under the specific circumstances outlined for the project.

Modifiers may apply depending on the specific circumstances of the visit and the services provided. Consult current modifier guidelines for appropriate usage.

Medical necessity for code G9055 is established by the need for the documented services provided during the visit within the context of the patient's cancer treatment and care.The services rendered must be clinically appropriate and medically necessary for the specific situation.

Only specialists in hematology and oncology who participate in the Medicare demonstration project can use this code.They are responsible for documenting the primary focus of the visit, disease status, and adherence to practice guidelines using this code and accompanying CPT codes.

IMPORTANT G9050-G9054 are other demonstration codes related to the primary purpose of visit. G9056-G9062 relate to adherence to practice guidelines, and G9063-G9130 concern the current disease status of Oncology.

In simple words: This code tells Medicare about the main reason for a cancer patient's doctor visit when the visit includes something not covered by other medical codes. It's used as part of a special Medicare study.

HCPCS code G9055 is used to indicate the primary focus of a visit for a cancer patient when the provider performs a service not specified by other codes within the Medicare demonstration project (initiated in 2006).This code must be reported alongside CPT codes specifying the visit's primary focus, disease status, and adherence to practice guidelines. Participation is limited to hematology/oncology specialists treating Medicare patients not enrolled in Medicare Advantage plans.G9050-G9054 list other relevant demonstration codes.

Example 1: A hematologist-oncologist sees a patient for a follow-up appointment after chemotherapy.The patient presents with fatigue and nausea. The physician addresses these symptoms and orders blood work.G9055 is used to report the primary focus of the visit (symptom management) along with CPT codes for the specific services rendered., An oncologist consults with a patient who has recently completed radiation therapy. The patient is experiencing skin reactions and needs further care. G9055 is reported, along with other codes detailing the consultation, management of side effects, and any additional testing or procedures. , A patient with metastatic cancer presents for a palliative care visit.The physician discusses quality-of-life measures, pain management, and addresses the patient's emotional and spiritual needs.G9055 is used to reflect the focus of the visit, supplemented by CPT codes for counseling and other services provided.

Detailed medical records documenting the patient's diagnosis, treatment plan, the reason for the visit, and the services rendered are essential.This includes progress notes, lab results, consultation reports, and any other relevant clinical documentation to support medical necessity.

** This code is specific to a Medicare demonstration project.Its usage is restricted to participating providers and patients.Always verify current eligibility and guidelines before using this code.

  • Payment Status: Active
  • Modifier TC rule: Not applicable.
  • Fee Schedule : Fee schedules vary and depend on the specific Medicare demonstration project.
  • Specialties:Hematology and Oncology
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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