How To Use HCPCS Code G9054

HCPCS code G9054 describes the oncology care provided to patients with terminal cancer or those who are unable to undergo further cancer treatment due to other medical illnesses. This code encompasses the supervision, coordination, and management of care for these patients, including symptom management, end-of-life care planning, and the management of palliative therapies. It is important for medical coders to understand the specific usage and guidelines for this code to ensure accurate billing and reimbursement.

1. What is HCPCS G9054?

HCPCS code G9054 is used to identify the oncology care provided to patients with terminal cancer or those who are unable to undergo further cancer treatment due to other medical illnesses. This code specifically pertains to the supervision, coordination, and management of care for these patients, including symptom management, end-of-life care planning, and the management of palliative therapies. It is important to note that this code is only applicable for use in a Medicare-approved demonstration project.

2. Official Description

The official description of HCPCS code G9054 is as follows: “Oncology; primary focus of visit; supervising, coordinating or managing care of patient with terminal cancer or for whom other medical illness prevents further cancer treatment; includes symptom management, end-of-life care planning, management of palliative therapies (for use in a Medicare-approved demonstration project).” The short description for this code is “Onc supervision palliative.”

3. Procedure

1. The provider begins by assessing the patient’s medical condition and determining the appropriate course of oncology care.
2. They supervise, coordinate, and manage the patient’s care, ensuring that all necessary symptom management and palliative therapies are provided.
3. The provider also engages in end-of-life care planning, addressing the patient’s physical, emotional, and spiritual needs.
4. Throughout the course of treatment, the provider closely monitors the patient’s progress and adjusts the care plan as necessary.
5. Documentation of all services provided and the patient’s response to treatment is essential for accurate billing and reimbursement.

4. When to use HCPCS code G9054

HCPCS code G9054 should be used when the primary focus of the visit is the supervision, coordination, and management of care for a patient with terminal cancer or for whom other medical illness prevents further cancer treatment. This code is specifically intended for use in a Medicare-approved demonstration project. It is important to review the specific eligibility criteria and guidelines for using this code to ensure accurate billing.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9054, healthcare providers must ensure that all necessary documentation is in place to support the services provided. This includes documentation of the patient’s terminal cancer diagnosis or the presence of other medical illnesses preventing further cancer treatment. Additionally, documentation should include details of the symptom management, end-of-life care planning, and management of palliative therapies provided. Accurate and thorough documentation is crucial for proper billing and reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G9054 was added to the Healthcare Common Procedure Coding System on January 1, 2006. It has an effective date of January 1, 2007. As of the provided information, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code G9054 is not payable by Medicare, as indicated by the coverage code I, which means it is not payable by Medicare. The pricing indicator code for this code is 00, which means the service is not separately priced by Part B. This indicates that the service is either not covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS is not priced separately by Part B or the value is not established.

8. Examples

Here are five examples of when HCPCS code G9054 should be billed:

1. A patient with terminal cancer receives ongoing oncology care, including symptom management and palliative therapies.
2. A patient with a medical illness preventing further cancer treatment requires end-of-life care planning and coordination of palliative therapies.
3. A healthcare provider supervises and manages the care of a patient with terminal cancer, ensuring appropriate symptom management and palliative therapies.
4. A patient with terminal cancer requires frequent adjustments to their care plan, necessitating close supervision and coordination by the healthcare provider.
5. A healthcare provider engages in end-of-life care planning and coordination of palliative therapies for a patient with a medical illness preventing further cancer treatment.