Question 1

What is HCPCS code G9078?

Accepted Answer

HCPCS code G9078 is "Onc dx prostate t2no progres". Oncology; disease status; prostate cancer, limited to adenocarcinoma as predominant cell type; t2 or t3a gleason 8-10 or psa > 20 at diagnosis with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)

Question 2

What category is G9078 in?

Accepted Answer

G9078 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9078?

Accepted Answer

Use G9078 when billing for onc dx prostate t2no progres. 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 G9078 covered by Medicare?

Accepted Answer

Coverage for G9078 (Onc dx prostate t2no progres) 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 G9078?

Accepted Answer

Documentation for G9078 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).