G9838 — Patient has metastatic disease at diagnosis
G9838 is a HCPCS Level II code for patient has metastatic disease at diagnosis. It belongs to the Procedures and Professional Services (Temporary) section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusM
Measurement code. Used for reporting purposes only; never paid.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for G9838
- Long descriptor
- Patient has metastatic disease at diagnosis
- Short descriptor
- Pt met dis at dx
- Added
- January 1, 2017
- BETOS
- Z2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to G9838
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If G9838 is not quite right, the correct code is very often within a few positions of it.
- G9830Her-2/neu positive
- G9831Ajcc stage at breast cancer diagnosis = ii or iii
- G9832Ajcc stage at breast cancer diagnosis = i (ia or ib) and t-stage at breast cancer diagnosis = t1c
- G9833Patient transfer to practice after initiation of chemotherapyterminated
- G9834Patient has metastatic disease at diagnosisterminated
- G9835Trastuzumab administered within 12 months of diagnosisterminated
- G9836Reason for not administering trastuzumab documented (e.g. patient declined, patient died, patient transferred, contraindication or other clinical exclusion, neoadjuvant chemotherapy or radiation not complete)terminated
- G9837Trastuzumab not administered within 12 months of diagnosisterminated
- G9839Anti-egfr monoclonal antibody therapy
- G9840Ras (kras and nras) gene mutation testing performed before initiation of anti-egfr moab
- G9841Ras (kras and nras) gene mutation testing not performed before initiation of anti-egfr moab
- G9842Patient has metastatic disease at diagnosis
- G9843Ras (kras or nras) gene mutation
- G9844Patient did not receive anti-egfr monoclonal antibody therapy
- G9845Patient received anti-egfr monoclonal antibody therapy
- G9846Patients who died from cancer
Questions about G9838
What is HCPCS code G9838?
G9838 is a HCPCS Level II code for patient has metastatic disease at diagnosis. It sits in the Procedures and Professional Services (Temporary) section.
Does Medicare cover G9838?
The CMS HCPCS file marks G9838 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is G9838 paid under the physician fee schedule?
G9838 carries PFS status code M. Measurement code. Used for reporting purposes only; never paid.