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Procedure Codes for SEER-Medicare Analyses

The tables below contain codes for procedures that are frequently included in SEER-Medicare analyses. Please note that NCI provides these codes to assist researchers in analyses. Codes may change or may not be complete. NCI does not accept responsibility for the completeness or currency of the information below. Investigators should check that all relevant codes are included in their analysis.

Chemotherapy Codes

  ICD-9 Diagnoses ICD-9 Procedures HCPCS Coding (with comments)
Administration V58.1 99.25 964xx, 96400-96549,
Q0083-Q0085
51720 (bladder instillation)
For CY2005, please see narrative below.
Specific drugs n/a n/a

Administered Intravenously (IV):
these will be found in the NCH and Outpatient data

J9000-J9999*

Administered Orally

Under Medicare Part B, chemotherapy is only covered if it is administered intravenously unless there is an oral agent that is an equivalent to a drug given IV, ex, capecitabine is an oral equivalent for 5-FU. Bills for oral drugs will appear in the Durable Medical Equipment (DME) file. CMS requires that drugs submitted to the DME be billed using 11-digit National Drugs Codes (NDCs). For patients in clinical trials, DME claims for drugs will be accepted using HCPCS codes.

Anti-emetics (if associated w/chemo) n/a n/a The types of anti-emetics available and covered by Medicare changes frequently. Investigators should consult the list of HCPCS.
Other V66.2, V67.2    

* Historically, HCPCS ranging from J9000-J9999 have been used to identify specific chemotherapeutic agents. However, in more recent years, a number of chemotherapeutic agents and related therapies (anti-emetics etc.) are assigned HCPCS outside of the J9000-J9999 range. Investigators should review the complete list of HCPCS to identify all relevant codes. Excel files with a list of Level II HCPCS can be downloaded from the CMS Web site.

Identifying Chemotherapy Codes in the SEER-Medicare Data - 2005 Claims Only (update 1/27/2010)

In 2005, CMS implemented the Oncology Demonstration Project. For providers participating in the demonstration project, there are specific HCPCS for chemotherapy administration in the physician and hospital outpatient data. (For G0355-G0363, see Medicare drug administration codes (PDF, 253 KB).) There are additional codes related to the assessment of symptoms associated with chemotherapy use (for G9021-G9032, see 2005 Medicare Demonstration Project Chemotherapy Codes). If these G codes are not included in an analysis, use of chemotherapy in 2005 will be underestimated. These codes are to be used in 2005 only.

Radiation Therapy Codes

  ICD-9 Diagnoses ICD-9 Procedures Revenue Center Codes HCPCS codes
Administration V58.0, V66.1
V67.1
92.21 – 92.29 0330, 0333 77401-77499, 77520**, 77523**, 77750-77799, G0256, G0261

** These codes are for proton beam therapy, which is not covered by most carriers. For those carriers who do cover it, the conditions for which the carrier will accept these codes are quite limited. Given the limited use of these codes, investigators should evaluate if they are relevant to their analysis.

Codes Used to Identify Screening & Related Procedures in the Medicare Claims for Selected Cancers

Type of test Screening Codes Diagnostic Codes
Mammogram 76092 76090-unilateral, 76091-bilateral
Prostate specific antigen (PSA) G0103 86316 (prior to 1988)
84153 (1988 and later)
Digital rectal examination G0102  
Fecal Occult Blood Tests (FOBT) G0107 82270-82273 (pathology codes)
Sigmoidoscopy G0104 w/biopsy removal:
45305, 45308, 45309, 45315, 45320, 45331
Colonoscopy G0105 (high risk)
G0121 (non-high risk)
w/biopsy removal:
45380, 45384, 45385
Double Contrast Barium Enema (DCBE) G0106, G0120, G0122  

Last Modified: 18 Oct 2013