Question 1

What is HCPCS code G9074?

Accepted Answer

HCPCS code G9074 is "Onc dx brst stg3-noprogress". Oncology; disease status; invasive female breast cancer (does not include ductal carcinoma in situ); adenocarcinoma as predominant cell type; stage iiia-iiib; and not t3, n1, m0; and er and pr negative; with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)

Question 2

What category is G9074 in?

Accepted Answer

G9074 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9074?

Accepted Answer

Use G9074 when billing for onc dx brst stg3-noprogress. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is G9074 covered by Medicare?

Accepted Answer

Coverage for G9074 (Onc dx brst stg3-noprogress) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for G9074?

Accepted Answer

Documentation for G9074 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).