2025 HCPCS code G9056
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Professional Services - Adherence to Practice Guidelines Medicare Demonstration Projects Feed
This HCPCS code reports adherence to practice guidelines for oncology treatment within a specific Medicare demonstration project.
Modifiers may be required depending on the circumstances of the service.Consult the appropriate modifier guidelines.
Medical necessity is established by the diagnosis of cancer and the need for adherence to evidence-based treatment guidelines to ensure optimal patient outcomes.This code's use is limited to the specific Medicare demonstration project.
Hematology-oncology specialists are responsible for documenting the patient's visit's primary focus, disease status, and adherence to guidelines, coding with the appropriate CPT and G-codes, including G9056.
In simple words: This code shows that a doctor followed specific guidelines when treating a cancer patient. It's used in a special Medicare program to study how cancer care works.
HCPCS code G9056 is used to report adherence to practice guidelines for oncology treatment as part of a Medicare-approved demonstration project (initiated in 2006).This code must be reported alongside CPT codes representing the primary focus of the patient visit, disease status, and guideline adherence.Only hematology-oncology specialists treating Medicare patients (excluding those in Medicare Advantage) can utilize this code.The demonstration project aims to evaluate the effects of potential program changes and gather additional data on cancer care.
Example 1: A 68-year-old Medicare beneficiary with metastatic melanoma is seen for a follow-up visit. The oncologist documents the primary focus as disease management (CPT code X), current disease status (CPT code Y), and adherence to established treatment guidelines (G9056). , A 72-year-old patient with newly diagnosed multiple myeloma undergoes consultation with a hematologist-oncologist. The consultation focuses on treatment planning (CPT code A), confirming diagnosis (CPT code B), and the plan aligns with evidence-based guidelines (G9056). , A 55-year-old patient with recurrent lymphoma receives a chemotherapy cycle.The physician documents the administration of chemotherapy (CPT code C), assesses response to treatment (CPT code D), and confirms that the treatment adheres to current guidelines (G9056).
Detailed documentation of the patient encounter is required, including the primary focus of the visit, disease status, and evidence of adherence to established treatment guidelines.Clinical notes should clearly support the selected CPT and HCPCS codes.
** This code's usage is restricted to participation in the specific Medicare demonstration project.The code is not for general use outside of that project.Consult the official Medicare documentation for the relevant demonstration project for detailed guidelines.
- RVU: Unknown.RVUs are not directly associated with this HCPCS code. Reimbursement is determined by the Medicare demonstration project's specific payment structure.
- Global Days : Not applicable. This is a professional service code, not a surgical procedure.
- Payment Status: Active (within the context of the specified Medicare demonstration project)
- Modifier TC rule: Not applicable.
- Fee Schedule : Unknown. Reimbursement is determined by the Medicare demonstration project's specific payment structure.
- Specialties:Hematology-Oncology
- Place of Service:Office, Hospital Outpatient