Question 1

What is HCPCS code G9080?

Accepted Answer

HCPCS code G9080 is "Onc dx prostate w/rise psa". Oncology; disease status; prostate cancer, limited to adenocarcinoma; after initial treatment with rising psa or failure of psa decline (for use in a medicare-approved demonstration project)

Question 2

What category is G9080 in?

Accepted Answer

G9080 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9080?

Accepted Answer

Use G9080 when billing for onc dx prostate w/rise psa. 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 G9080 covered by Medicare?

Accepted Answer

Coverage for G9080 (Onc dx prostate w/rise psa) 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 G9080?

Accepted Answer

Documentation for G9080 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).