Question 1

What is HCPCS code G9116?

Accepted Answer

HCPCS code G9116 is "Onc dx ovarian recurrence". Oncology; disease status; ovarian cancer, limited to epithelial cancer; evidence of disease progression, or recurrence, and/or platinum resistance (for use in a medicare-approved demonstration project)

Question 2

What category is G9116 in?

Accepted Answer

G9116 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9116?

Accepted Answer

Use G9116 when billing for onc dx ovarian recurrence. 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 G9116 covered by Medicare?

Accepted Answer

Coverage for G9116 (Onc dx ovarian recurrence) 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 G9116?

Accepted Answer

Documentation for G9116 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).