G8880 – Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)

Long description

Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, clinically node positive after neoadjuvant systemic therapy, patient refusal after informed consent, patient with significant age, comorbidities, or limited life expectancy and favorable tumor; adjuvant systemic therapy unlikely to change)

Short description

Sen lym p node biop not perf

Pricing indicator

00 Not separately priced by Part B (bundled, not covered or Part A only)

Medicare coverage

C Carrier judgment – coverage decided by the Medicare contractor

BETOS category

M5B Specialist - psychiatry

Added

January 1, 2012

Last change

January 1, 2019 – No change

Nearby G codes

• G8872 – Excised tissue evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
• G8873 – Patients with needle localization specimens which are not amenable to intraoperative imaging such as mri needle wire localization, or targets which are tentatively identified on mammogram or ultrasound which do not contain a biopsy marker but which can be verified on intraoperative inspection or pathology (e.g., needle biopsy site where the biopsy marker is remote from the actual biopsy site)
• G8874 – Excised tissue not evaluated by imaging intraoperatively to confirm successful inclusion of targeted lesion
• G8875 – Clinician diagnosed breast cancer preoperatively by a minimally invasive biopsy method
• G8876 – Documentation of reason(s) for not performing minimally invasive biopsy to diagnose breast cancer preoperatively (e.g., lesion too close to skin, implant, chest wall, etc., lesion could not be adequately visualized for needle biopsy, patient condition prevents needle biopsy [weight, breast thickness, etc.], duct excision without imaging abnormality, prophylactic mastectomy, reduction mammoplasty, excisional biopsy performed by another physician)
• G8877 – Clinician did not attempt to achieve the diagnosis of breast cancer preoperatively by a minimally invasive biopsy method, reason not given
• G8878 – Sentinel lymph node biopsy procedure performed
• G8879 – Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer
• G8881 – Stage of breast cancer is greater than t1n0m0 or t2n0m0
• G8882 – Sentinel lymph node biopsy procedure not performed, reason not given
• G8883 – Biopsy results reviewed, communicated, tracked and documented
• G8884 – Clinician documented reason that patient's biopsy results were not reviewed
• G8885 – Biopsy results not reviewed, communicated, tracked or documented
• G8886 – Most recent blood pressure under control
• G8887 – Documentation of medical reason(s) for most recent blood pressure not being under control (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate)
• G8888 – Most recent blood pressure not under control, results documented and reviewed