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.*
The NCI Observational Research in Oncology Toolbox may also be helpful.
|ICD Diagnoses||ICD Procedures||HCPCS Coding (with comments)|
ICD10: 3E03305, 3E04305, XW03351, XW033B3, XW033C3, XW04351, XW043B3, XW043C3
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
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||ICD9: V66.2, V67.2
ICD10: Z51.89, Z08
* 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 Diagnoses||ICD Procedures||Revenue Center Codes||HCPCS codes|
|Administration||ICD9: V58.0, V66.1, V67.1
ICD10: Z51.0, Z51.89, Z08
|ICD9: 92.21 – 92.29
ICD10: See D-Radiation, DB0-Beam Radiation
|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|
|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)|
45305, 45308, 45309, 45315, 45320, 45331
|Colonoscopy||G0105 (high risk)
G0121 (non-high risk)
45380, 45384, 45385
|Double Contrast Barium Enema (DCBE)||G0106, G0120, G0122|