How To Use HCPCS Code G9055

HCPCS code G9055 describes a specific service within the field of oncology. This code is used to identify the primary focus of a visit related to oncology, when the service provided does not fall under any other specified code. It is important for medical coders to understand the meaning and usage of this code in order to accurately document and bill for the services rendered.

1. What is HCPCS G9055?

HCPCS code G9055 is used to identify a visit with a primary focus on oncology, when the service provided does not fall under any other specified code. This code is typically used in the context of a Medicare-approved demonstration project. It is important to note that this code is not payable by Medicare, as indicated by the coverage code I.

2. Official Description

The official description of HCPCS code G9055 is “Oncology; primary focus of visit; other, unspecified service not otherwise listed (for use in a Medicare-approved demonstration project)”. The short description for this code is “Onc visit unspecified nos”.

3. Procedure

1. When using HCPCS code G9055, the healthcare provider should clearly document the primary focus of the visit, which is oncology.
2. The provider should also document any other services provided during the visit that are not covered by other specified codes.
3. It is important to accurately document the details of the visit and the services rendered in order to support proper coding and billing.

4. When to use HCPCS code G9055

HCPCS code G9055 should be used when the primary focus of a visit is oncology and the service provided does not fall under any other specified code. This code is typically used in the context of a Medicare-approved demonstration project. It is important to review the specific guidelines and eligibility criteria for using this code in order to ensure accurate coding and billing.

5. Billing Guidelines and Documentation Requirements

When billing for services using HCPCS code G9055, healthcare providers should ensure that the documentation supports the primary focus of the visit on oncology and any other services provided that are not covered by other specified codes. It is important to accurately document the details of the visit, including the reason for the visit, any procedures performed, and any other relevant information. This documentation will help support proper coding and billing for the services rendered.

6. Historical Information and Code Maintenance

HCPCS code G9055 was added to the Healthcare Common Procedure Coding System on January 01, 2006. There have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to stay updated on any changes or revisions to the code in order to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

HCPCS code G9055 is not payable by Medicare, as indicated by the coverage code I. The pricing indicator code for this code is 00, which means that the service is not separately priced by Part B. This could be due to the service not being covered, bundled, or used by Part A only. The multiple pricing indicator code is 9, which means that it is not applicable as HCPCS is not priced separately by Part B or the value is not established. It is important to review the specific coverage and pricing guidelines of Medicare and other insurance providers when using this code.

8. Examples

Here are five examples of when HCPCS code G9055 should be billed:

1. A patient visits an oncology clinic for a routine follow-up appointment to discuss their treatment plan and progress.
2. A patient undergoes a diagnostic procedure related to oncology, such as a biopsy or imaging study.
3. A patient receives counseling or education on managing the side effects of their cancer treatment.
4. A patient undergoes a minor surgical procedure related to their oncology treatment.
5. A patient receives a medication infusion or injection as part of their oncology treatment.