G9091 HCPCS code: Oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project)
G9091 is the HCPCS Level II code for oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project). Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | P7B |
| Added | 2006-01-01 |
| Last action effective | 2007-01-01 |
What changed for G9091
- 2006-01-01: G9091 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G9091?
G9091 is the HCPCS Level II code for oncology; disease status; rectal cancer, limited to invasive cancer, adenocarcinoma as predominant cell type; extent of disease initially established as t3, n0, m0 (prior to neo-adjuvant therapy, if any) with no evidence of disease progression, recurrence, or metastases (for use in a medicare-approved demonstration project). Short descriptor: "Onc dx rectal t3 n0 no prog".
Does Medicare cover G9091?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Related G90 codes
- G9001 — Coordinated care fee, initial rate
- G9002 — Coordinated care fee, maintenance rate
- G9003 — Coordinated care fee, risk adjusted high, initial
- G9004 — Coordinated care fee, risk adjusted low, initial
- G9005 — Coordinated care fee, risk adjusted maintenance
- G9006 — Coordinated care fee, home monitoring
- G9007 — Coordinated care fee, scheduled team conference
- G9008 — Coordinated care fee, physician coordinated care oversight services
- G9009 — Coordinated care fee, risk adjusted maintenance, level 3
- G9010 — Coordinated care fee, risk adjusted maintenance, level 4
- G9011 — Coordinated care fee, risk adjusted maintenance, level 5
- G9012 — Other specified case management service not elsewhere classified
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Next steps
- Run a reimbursement report for a device billed under G9091
- Watch G9091 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for G9091
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.