How To Use HCPCS Code G9678

HCPCS code G9678 describes the Oncology Care Model (OCM) Monthly Enhanced Oncology Services (MEOS) payment for OCM enhanced services. This code is specifically used for OCM practitioners who provide enhanced services to OCM beneficiaries, as defined in the OCM participation agreement. It is important to note that G9678 payments may only be made for the furnishment of enhanced services as outlined in the agreement.

1. What is HCPCS G9678?

HCPCS code G9678 is a specific code used to identify the Oncology Care Model (OCM) Monthly Enhanced Oncology Services (MEOS) payment for OCM enhanced services. It is used by OCM practitioners who provide these enhanced services to OCM beneficiaries. The code was added to the Healthcare Common Procedure Coding System on April 01, 2016, and it is effective starting July 01, 2022. However, it is important to note that this code has been terminated as of June 30, 2022.

2. Official Description

The official description of HCPCS code G9678 is “Oncology care model (OCM) monthly enhanced oncology services (MEOS) payment for OCM enhanced services.” The short description for this code is “Oncology care model service.”

3. Procedure

1. As an OCM practitioner, you need to provide enhanced services to OCM beneficiaries as defined in the OCM participation agreement.
2. Ensure that the services provided meet the criteria outlined in the agreement.
3. Document the details of the enhanced services provided, including any additional care or interventions beyond standard oncology care.
4. Submit the claim using HCPCS code G9678 to indicate the provision of OCM Monthly Enhanced Oncology Services.

4. When to use HCPCS code G9678

HCPCS code G9678 should be used when you are an OCM practitioner providing enhanced services to OCM beneficiaries. These enhanced services must align with the definition and criteria outlined in the OCM participation agreement. It is important to note that G9678 payments may only be made for the furnishment of enhanced services as defined in the agreement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G9678, it is crucial to ensure accurate documentation and adherence to billing guidelines. Here are some key points to consider:

• Document the specific enhanced services provided to OCM beneficiaries.
• Include any additional care or interventions beyond standard oncology care.
• Submit the claim using HCPCS code G9678 to indicate the provision of OCM Monthly Enhanced Oncology Services.

6. Historical Information and Code Maintenance

HCPCS code G9678 was added to the Healthcare Common Procedure Coding System on April 01, 2016. It has an effective date of July 01, 2022. However, it is important to note that this code has been terminated as of June 30, 2022. 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

Medicare coverage for HCPCS code G9678 may vary. It is essential to consult the Medicare guidelines and policies to determine if this code is payable. The pricing indicator code for G9678 is 00, which means the service is not separately priced by Part B. This indicates that the service may not be covered or may be bundled with other services. The multiple pricing indicator code is 9, which means it is not applicable as HCPCS G9678 is not priced separately by Part B.

8. Examples

Here are some examples of when HCPCS code G9678 should be billed:

1. Example 1: An OCM practitioner provides additional counseling and support services to an OCM beneficiary beyond standard oncology care.
2. Example 2: An OCM practitioner coordinates and manages the care of an OCM beneficiary, including collaboration with other healthcare providers.
3. Example 3: An OCM practitioner conducts regular check-ins and follow-ups with an OCM beneficiary to ensure comprehensive care.
4. Example 4: An OCM practitioner provides education and resources to an OCM beneficiary to enhance their understanding of their condition and treatment options.
5. Example 5: An OCM practitioner offers specialized services, such as genetic counseling or palliative care, to an OCM beneficiary.