Question 1

What is HCPCS code G8880?

Accepted Answer

HCPCS code G8880 is "Sen lym p node biop not perf". Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)

Question 2

What category is G8880 in?

Accepted Answer

G8880 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G8880?

Accepted Answer

Use G8880 when billing for sen lym p node biop not perf. 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 G8880 covered by Medicare?

Accepted Answer

Coverage for G8880 (Sen lym p node biop not perf) 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 G8880?

Accepted Answer

Documentation for G8880 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).