In simple words: This code shows that a doctor's treatment plan for a cancer patient is different from usual because the patient is in a special medical research study. The doctor uses this code to explain why their treatment is different, as part of a government-approved program.

This HCPCS code (G9057) indicates that a patient's care differs from established practice guidelines because they are participating in an Institutional Review Board (IRB)-approved clinical trial.It's part of a Medicare demonstration project (started in 2006) requiring reporting alongside CPT codes specifying the visit's primary focus, disease status, and guideline adherence.Only hematology/oncology specialists treating non-Medicare Advantage Medicare patients can use this code within the project.It signifies deviation from guidelines (G9050-G9054) due to clinical trial protocols.

Example 1: A 68-year-old Medicare patient with metastatic breast cancer is enrolled in a Phase III clinical trial testing a new targeted therapy.The oncologist uses G9057 to report that the treatment plan deviates from standard guidelines due to the trial protocol.The oncologist also submits CPT codes detailing the visit's focus (assessment), the patient's disease stage, and adherence (or non-adherence) to standard guidelines., A 72-year-old Medicare patient with multiple myeloma is participating in a clinical trial investigating a novel immunotherapy.The hematologist/oncologist utilizes G9057 to indicate the divergence from standard treatment algorithms.Accompanying CPT codes depict the visit's purpose, the patient's disease progression, and compliance with or variance from typical practice guidelines., A 55-year-old Medicare patient with advanced lung cancer is enrolled in a study exploring a new chemotherapy regimen. The oncologist reports G9057 to document the treatment variations necessitated by the clinical trial. The associated CPT codes reflect the nature of the visit, disease status, and the conformity or departure from established practice guidelines.

Detailed clinical notes outlining the patient's participation in the IRB-approved clinical trial, the specific protocol deviations, CPT codes for visit focus, disease status, and guideline adherence, and the patient's Medicare eligibility status.

** This code is highly specific and limited to participation in the described Medicare demonstration project.Accurate use requires a thorough understanding of the project's parameters and strict adherence to documentation requirements.Incorrect use may lead to claim denials.