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See a sample rate comparisonHCPCS G9911 Fee Schedule
HCPCS G9911 is classified under Procedures / Professional Services, in the Breast screening (Therapeutics) subgroup.
Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy
| Key Fact | Detail |
|---|---|
| Service Type | Procedures / Professional Services Breast screening (Therapeutics) |
| Complexity Level | Low |
National average reimbursement for HCPCS G9911 by major payers:
$71.05
BCBS / Anthem
$N/A
UnitedHealthcare
$0.01
Aetna
$1.16
Cigna
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HCPCS G9911
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See a sample payer proposalHCPCS G9911 vs. Other Breast screening (Therapeutics) Codes
The table lists codes related to G9911. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| G9910-HCPCS | Low | Patients age 66 or older in institutional special needs plans (snp) or residing in long-term care with pos code 32, 33, 34, 54 or 56 for more than 90 consecutive days during the measurement period |
| G9911-HCPCS | Low | Clinically node negative (t1n0m0 or t2n0m0) invasive breast cancer before or after neoadjuvant systemic therapy |
| G9912-HCPCS | Low | Hepatitis B virus (HBV) status assessed and results interpreted prior to initiating anti-TNF (tumor necrosis factor) therapy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS G9911. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the G9911 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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