Question 1

What is HCPCS code G9094?

Accepted Answer

HCPCS code G9094 is "Onc dx rectal m1 w/mets prog". Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; m1 at diagnosis, metastatic, locally recurrent, or progressive (for use in a medicare-approved demonstration project)

Question 2

What category is G9094 in?

Accepted Answer

G9094 belongs to HCPCS Category G (Procedures/Professional Services).

Question 3

When should I use HCPCS code G9094?

Accepted Answer

Use G9094 when billing for onc dx rectal m1 w/mets prog. 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 G9094 covered by Medicare?

Accepted Answer

Coverage for G9094 (Onc dx rectal m1 w/mets prog) 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 G9094?

Accepted Answer

Documentation for G9094 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).