Question 1

What is HCPCS code G9079?

Accepted Answer

HCPCS code G9079 is "Onc dx prostate t3b-t4noprog". Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t3b-t4, any n; any t, n1 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)

Question 2

What category is G9079 in?

Accepted Answer

G9079 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9079?

Accepted Answer

Use G9079 when billing for onc dx prostate t3b-t4noprog. 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 G9079 covered by Medicare?

Accepted Answer

Coverage for G9079 (Onc dx prostate t3b-t4noprog) 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 G9079?

Accepted Answer

Documentation for G9079 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).