DRAFT LCD Reference Article Billing and Coding Article

Billing and Coding: Genetic Testing for Oncology

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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A59125
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DA59125
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Billing and Coding: Genetic Testing for Oncology
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Billing and Coding
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CMS National Coverage Policy

Internet-Only Manuals (IOMs):

  • CMS IOM Publication 100-04, Medicare Claims Processing Manual,
    • Chapter 16, Section 10 Background, Section 40.8 Date of Service (DOS) for Clinical Laboratory and Pathology Specimens and Section 120.1 Negotiated Rulemaking Implementation
    • Chapter 18 Preventive and Screening Services
  • CMS IOM Publication 100-08, Medicare Program Integrity Manual,
    • Chapter 3 Verifying Potential Errors and Taking Corrective Actions

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Code of Federal Regulations (CFR) References:

  • CFR, Title 42, Subchapter B, Part 410 Supplementary Medical Insurance (SMI) Benefits, Section 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions
  • CFR, Title 42, Section 414.502 Definitions
  • CFR, Title 42, Subpart G, Section 414.507 Payment for clinical diagnostic laboratory tests and Section 414.510 Laboratory date of service for clinical laboratory and pathology specimens
  • CFR, Title 42, Part 493 Laboratory Requirements
  • CFR, Title 42, Section 493.1253 Standard: Establishment and verification of performance specifications
  • CFR, Title 42, Section 1395y(b)(1)(F) Limitation on beneficiary liability

Medicare National Correct Coding Initiative (NCCI) Policy Manual:

  • Chapter 10, Section F Molecular Pathology
  • Chapter 10, Section M Medically Unlikely Edits (MUEs)

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L39365 Genetic Testing for Oncology. Please refer to the LCD for reasonable and necessary requirements.

All instructions provided within the American Medical Association (AMA) Current Procedural Terminology (CPT) Codebook with rules and guidelines from the AMA’s CPT Editorial Panel and the Medicare NCCI Policy Manual should be followed when utilizing CPT codes for billing. Proper coding involves interpreting code descriptions provided by these sources as well as any associated parentheticals. The instructions below do not represent the full breadth or depth of instructions found in the CPT Codebook and the Medicare NCCI Policy Manual. Providers that bill Medicare are expected to follow all instructions found in these sources.

Molecular code descriptions in the CPT Codebook generally have some or all of the following components:

  1. Medical condition under investigation
  2. Genetic content to be tested
  3. Technology/methodology used for testing
  4. Specimen type evaluated

Providers must ensure that their use of molecular CPT codes represent the highest level of specificity in what testing was performed. The following reviews each of these components with general tips for each:

1. Medical Condition

When a code designates coverage of a specific medical condition (e.g., CPT code 81432 - “Hereditary breast cancer- related disorders”), all genes billed under this code must fall under the description of the medical condition. Even if all the genes described by a CPT code are tested in a claim, the CPT code can only be used if the described medical condition matches the documented disease.

2. Genetic Content

Commonly, molecular CPT codes have a gene(s) listed within their coding description. Special attention must be paid to what elements of a gene are analyzed since not all codes describe the analysis of an entire gene. A gene could be tested for a single well-known variant (e.g., CPT code 81210 - V600 variants in the BRAF gene) or the gene could be fully sequenced (e.g., CPT code 81406 – full sequence of the BRAF gene). In fact, several codes in the Tier 1 molecular section cover the same gene but differ in what element of that gene they cover.

  • For instance, the CPT codes 81201, 81202, and 81203 all describe tests for the same gene, APC, but cover different elements of the gene such as full gene sequence, known familial variants or duplication/deletion variants.
  • As stated in the Medicare NCCI Policy Manual Chapter 10, these codes in general should not be billed together. An exception could be in uncommon scenarios such as billing a code for “full gene sequence” with another code for “duplication/deletion variants” when the disease variants cannot be identified by performing full gene sequencing. “Procedures reported together must be both medically reasonable and necessary (e.g., sequencing of procedures) and ordered by the physician who is treating the beneficiary and using the results in the management of the beneficiary's specific medical problem.”

Less commonly, molecular CPT codes are defined by only a test methodology, as is seen in codes for Fluorescence In Situ Hybridization (FISH) found in the Surgical Pathology section of the CPT Codebook. In brief, FISH is a technique where a probe (a short, single-stranded nucleic acid sequence) targets a specific genetic sequence and is labeled/tagged with a fluorescent dye. If the target is found, the fluorescent dye becomes attached to that target and can be seen under microscopy or other related imaging. In oncology, FISH probes are used to evaluate many different genes for many different cancers; however, many FISH CPT codes do not specify which genes or which cancers are being evaluated. As a result, special attention must be paid to what unit of service (UOS) is found in the code description.

A UOS for FISH testing could be defined in numerous ways, including number of slides evaluated, number of single source specimens evaluated, number of FISH probes used, number of FISH procedures performed, or number of cells counted. For Medicare, both the CPT Codebook and the Medicare NCCI Policy Manual specify which of these UOS applies, and billing for more UOS than were actually performed is not permitted.

The NCCI manual states that regardless of how many blocks or slides are created from a surgical, cytologic, or hematologic specimen, testing multiple blocks or slides from the same specimen source (e.g., tube of blood) still is considered as 1 UOS per source specimen.

For example:

  • The UOS described for CPT code 88373 is both “per specimen” and “each additional single probe stain procedure.” Depending on the testing scenario, the code may or may not be used, and should only be used in relation to additional probes NOT additional specimens.
    • If one single probe procedure is used for a specimen from one source (e.g., right iliac crest bone marrow aspiration), only 1 UOS may be claimed, even if multiple slides from the specimen are tested with the same probe:
    • 1 UOS with the parent CPT code 88367,
    • 0 UOS should be reported with CPT code 88373 since only one single probe procedure was used, regardless of how many slides are made with the single source specimen.
  • If two different single probe procedures are used to evaluate several slides from one source specimen, only 2 UOS may be claimed:
    • 1 UOS with the parent CPT code 88367, AND
    • 1 UOS with the additional CPT code 88373
  • If one single probe procedure is used on two source specimens (e.g., one bone marrow aspiration specimen from the right iliac crest and another specimen from the left iliac crest), only 2 UOS may be claimed:
    • 2 UOS with the parent CPT code 88367,
    • 0 UOS should be reported with CPT code 88373 since only one single probe procedure was used.
  • The same logic for single probe stain procedures is also true of using multiplex probe stain procedures (CPT code 88374); the UOS is based on the overall multiplex probe stain procedure NOT the number of probes within the multiplex stain.

CPT codes that describe a genomic sequencing panel (GSP) often include instructions that define the number of genes covered, for instance using a range (5-50 genes) or using a minimum number required (e.g., “at least” 10 genes).

For instance:

  • CPT code 81436 covers at least five genes and must include the genes MLH1, MSH2, EPCAM, SMAD4, and STK11.
  • This means any test matching the CPT code description for 81436, regardless of whether the test analyzed five genes or 20 genes, would be billed under the CPT code 81436 code with only 1 UOS.
  • Additionally, this means that any test without all five mandatory genes (MLH1, MSH2, EPCAM, SMAD4, and STK11) would NOT be billed with this code.
  • When a CPT code for a panel is used in this context, no other CPT codes may be used to describe the panel, regardless of presence or absence of modifiers.

3. Technology/Methodology

When a CPT code description specifies a particular technology and/or testing methodology, only that technology and/or methodology may be used when billing that code. Therefore, special attention must be paid to the full code description, especially if the type of content tested has technology that typically varies from CPT code to CPT code. For example, CPT codes describing a gene expression profiling (GEP) test often include the specific methodology used for that test, such as RT-PCR (e.g., 81518), microarray (e.g., 81521), and next-generation sequencing (e.g., 81523).

Conversely, if a technology and/or methodology is NOT specified in a code description, there is no need to match the technology and/or methodology to that code (e.g., a full sequence analysis of three different genes can be performed by Sanger Sequencing or NGS). For example, CPT code 81279 describes targeted sequence analysis for the gene JAK2 without specifying a sequencing technology. JAK2 is often part of a sequence of reflexive tests evaluating for a myeloproliferative neoplasm, and commonly each step is performed using real time/quantitative (RT/q) PCR. However, each step of that testing sequence could also be performed with Sanger sequencing technology. Additionally, JAK2 could be part of a small NGS panel test with other genes, which, if less than five genes, could be billed as CPT code 81279 and three additional CPT codes representing three other genes. Finally, as technology advances, whole exome/genome sequencing is being utilized more and more as a backbone to customized testing, wherein all unanalyzed data is masked (only certain genetic content is made visible while the rest of the data is hidden from the interpreter) and only a smaller set of genes is analyzed and billed. The benefit to this newer method is the collected data can be reanalyzed as additional customized panels by unmasking additional genetic content without having to rerun the whole exome/genome sequencing. Again, if the custom panel is small, CPT code 81279 would be billed in tandem with up to three other gene codes.

Per the Medicare NCCI Policy Manual Chapter 10, “A Tier 1 or Tier 2 molecular pathology procedure CPT code should not, in general, be reported with a genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis, or proprietary laboratory analysis CPT code where the CPT code descriptor includes testing for the analyte described by the Tier 1 or Tier 2 molecular pathology code. Procedures reported together must be both medically reasonable and necessary (e.g., sequencing of procedures) and ordered by the physician who is treating the beneficiary and using the results in the management of the beneficiary's specific medical problem.”

4. Specimen Type

Some CPT codes (particularly PLA codes) define what type of specimens or specimen sources are covered by the code description. For instance, some multianalyte assays with algorithmic analyses evaluate gene expression in tumor tissue. Sometimes these tests are restricted to fresh tissue whereas other tests have been optimized to use formalin-fixed, paraffin-embedded tissue. These definitions are often clearly stated within the CPT code description and must be followed when present.

Definitions

Providers should be familiar with all terminology found within the CPT code descriptions before billing Medicare for these codes. Many of the molecular terms utilized in the CPT Codebook describe specific parameters that limit a code’s scope of coverage. Definitions are frequently provided at the beginning of sections and subsections within the CPT Codebook. The following are selected definitions of terminology and phrases commonly seen in the code descriptions:

  • “always including”/“must include”: Targets that are required in testing described by a CPT code.
  • “at least”/“or greater”: Minimum number of genes required to bill for a specific CPT code.
    • For instance, if a CPT code description for a panel requires “at least” 10 genes, this means the panel size must, at minimum, analyze 10 genes. However, if the panel analyzes 11, 20, 50, or 100 genes and this code is used, no other codes may be used to describe the panel, regardless of presence or absence of modifiers.
  • Common variants/Common deletions/etc.: Genetic variants most predominantly associated with a disease, as defined by professional society guidelines. Billing CPT codes with “common” variants in the code description should not include testing for uncommon and/or rare variants. If a variant is felt to be “common,” this designation must be supported by a professional society’s guidelines.
  • Deletion/duplication analysis: Testing that evaluates for loss (deletion) or gain (duplication) of stretches of genetic sequence (dosage of a particular genomic region).
  • “e.g.,”: Examples of … Depending on the context, listed examples following an “e.g.,” may or may not be required in the testing described by a code.
  • Full gene sequence/full sequence analysis: Testing that evaluates, at a minimum, all exons of a gene. Depending on the testing methodology used, a full sequence analysis may also include additional non-coding sequence (e.g., promotor region, introns) and/or may NOT include data on certain types of variants, such as duplication/deletion variants.
  • Qualitative: Results of a test provided as descriptive terms (e.g., positive, negative, inconclusive).
  • Quantitative: Results of a test provided as numeric measurements/values (e.g., International Units per milliliter [IU/mL]).
  • Targeted genomic sequence analysis/targeted sequence analysis: Typically defined as testing that focuses on (targets) a specific part(s) of a gene. This term is also used to describe selective review of larger regions of the genome when the term is used in the context of more comprehensive sequencing, such as whole genome/exome sequencing.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Per the Medicare NCCI Policy Manual Chapter 10, “CPT codes 81445, 81450, and 81455 describe targeted genomic sequence, DNA analysis or combined DNA and RNA analysis. CPT code 81445 applies to solid organ neoplasm type (5-50 genes) and CPT code 81450 applies to hematolymphoid neoplasm type (5-50 genes), while CPT code 81455 applies to the number of genes analyzed for either a solid or hematolymphoid neoplasm (51 or greater genes). Providers/suppliers may not report CPT code 81455 with either CPT code 81445 or 81450. CPT codes 81449, 81451, and 81456 describe targeted genomic sequence RNA analysis using a separate method.”

“All genomic sequencing procedures and molecular multianalyte assays (e.g., CPT codes 81410-81471), many multianalyte assays with algorithmic analyses (e.g., CPT codes 81490-81599, 0004M-XXXXM), and many Proprietary Laboratory Analyses (PLA) (e.g., CPT codes 0001U-XXXXU) are DNA or RNA analytic methods that simultaneously assay multiple genes or genetic regions. A provider/supplier shall not separately report testing for the same gene or genetic region by a different methodology (e.g., CPT codes 81105-81408, 81479, 88364-88377). CMS payment policy does not allow separate payment for multiple methods to test for the same analyte.”

“If one laboratory procedure evaluates multiple genes using a next generation sequencing procedure, the laboratory shall report only one unit of service of one genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis, or proprietary laboratory analysis CPT code. If no CPT code accurately describes the procedure performed, the laboratory may report CPT code 81479 (Unlisted molecular pathology procedure) with one unit of service or may report multiple individual CPT codes describing the component test results when medically reasonable and necessary. Procedures reported together must be both medically reasonable and necessary (e.g., sequencing of procedures) and ordered by the physician who is treating the beneficiary and using the results in the management of the beneficiary's specific medical problem.”

For tests that are genomic sequencing procedures that simultaneously assay multiple genes or genetic regions, coverage would be dependent on the genetic content examined and whether the content is covered for the patient’s specific medical condition by the LCD.

  • A targeted genomic sequence analysis panel that tests 5 to 50 genes and contains genes that meets LCD coverage criteria for the management of the patient’s specific medical condition to improve the patient’s outcome may be billed with CPT codes 81445, 81449, 81450, or 81451.
  • A targeted genomic sequence analysis panel that tests for 51 or greater genes and contains genes that meets LCD coverage criteria for the management of the patient’s specific medical condition to improve the patient’s outcome may be billed with the CPT codes 81455 or 81456.
  • A targeted genomic sequence analysis panel that tests five or greater genes and contains NO genetic content covered by the LCD criteria is billed with CPT codes 81445, 81449, 81450, 81451, 81455, or 81456 and the appropriate modifier to indicate a non-covered service.

It would not be expected that providers would perform, for an oncologic condition, a genomic sequencing procedure (e.g., next generation sequencing) that simultaneously assays multiple genes or genetic regions which would not be accurately described by CPT codes 81445, 81449, 81450, 81451, 81455 or 81456. Frequent utilization of CPT code 81479 and/or multiple individual CPT codes describing the component test results will be subject to review.

Note: For coverage information regarding CPT codes 0022U, 0037U, 0111U, 0172U, 0239U, and 0242U, please refer to NCD 90.2 Next Generation Sequencing (NGS).

Note: For all DNA-only NGS testing for non-hematologic malignancies, the NCD 90.2 section B or section D criteria must be met.

The NCD 90.2 is only applicable to DNA sequencing diagnostic laboratory tests using NGS for non-hematologic, somatic (acquired) and germline (inherited) cancers.

  • For non-hematologic DNA sequencing NGS tests that meet CMS FDA approval or clearance in NCD 90.2 section B.1.b. or section B.2.b., follow NCD requirements in section B.1.a. or section B.2.a.
  • For non-hematologic DNA sequencing NGS tests that do not meet CMS NCD 90.2 section B requirements that are performed in CLIA-certified laboratories, refer to NCD 90.2 section D AND the LCD for coverage criteria.
  • For NGS tests with combined DNA and RNA analysis of somatic and germline cancers, RNA analysis of somatic and germline cancers, and NGS tests for hematologic cancers, refer to the LCD for coverage criteria.

Note: For coverage information regarding CPT codes 88230 through 88291, please refer to NCD 190.3 Cytogenetics Studies.

Note: For coverage information regarding CPT code 81327 and 81528, please refer to NCD 210.3 Colorectal Cancer Screening Tests.

Note: Unlisted CPT codes 81479, 81599, and 88299 will be reviewed on a claim-by-claim basis to determine if coverage criteria in an NCD and/or an LCD are met. Include the gene(s) or specific laboratory test name on the claim and submit documentation with the claim to support the service was performed and meets LCD coverage criteria.

For coding guidance on Tier 1 and Tier 2 codes, CPT code 81479 (Unlisted Molecular Pathology), testing for multiple genes, -59 Modifier, Next Generation Sequencing (NGS), Genomic Sequencing Profiles (GSP), Multianalyte Assays with Algorithmic Analyses (MAAAs) and Proprietary Laboratory Analyses (PLAs), please refer to the billing and coding article A58917 Molecular Pathology and Genetic Testing.

Table 1. Tier 2 codes’ genes meeting LCD coverage criteria

 

Gene/Test

CPT Code

Covered Indications per review of NCCN, OncoKB and/or ClinGen

ABL1 (ABL proto oncogene 1, non-receptor tyrosine kinase) (e.g., acquired imatinib resistance), T315I variant

81401

Acute Lymphoblastic Leukemia, Chronic Myeloid Leukemia, B-Lymphoblastic Lymphoma

 

CBFB/MYH11 (inv(16)) (e.g., acute myeloid leukemia), qualitative, and quantitative, if performed

81401

Acute Myeloid Leukemia

DEK/NUP214 (t(6;9))(e.g., acute myeloid leukemia), translocation analysis, qualitative, and quantitative, if performed

81401

Acute Myeloid Leukemia

E2A/PBX1 (t(1;19)) (e.g., acute lymphocytic leukemia), translocation analysis, qualitative, and quantitative, if performed

81401

Acute Lymphoblastic Leukemia, B-Lymphoblastic Lymphoma

 

EML4/ALK (inv(2)) (e.g., non-small cell lung cancer), translocation or inversion analysis

81401

Non-Small Cell Lung Cancer

 

ETV6/RUNX1 (t(12;21)) (e.g., acute lymphocytic leukemia), translocation analysis, qualitative and quantitative, if performed

81401

Acute Lymphoblastic Leukemia, B-Lymphoblastic Lymphoma

EWSR1/ATF1 (t(12;22)) (e.g., clear cell sarcoma), translocation analysis, qualitative, and quantitative, if performed

81401

Soft Tissue Sarcoma-Angiomatoid Fibrous Histiocytoma, Soft Tissue Sarcoma-Clear Cell Sarcoma

EWSR1/ERG (t(21;22)) (e.g., Ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative and quantitative, if performed

81401

Bone Cancer – Ewing Sarcoma, Soft Tissue Sarcoma - Ewing Sarcoma/Peripheral Neuroectodermal Tumor

EWSR1/FLI1 (t(11;22)) (e.g., Ewing sarcoma/peripheral neuroectodermal tumor), translocation analysis, qualitative and quantitative, if performed

81401

Bone Cancer – Ewing Sarcoma, Soft Tissue Sarcoma - Ewing Sarcoma/Peripheral Neuroectodermal Tumor

EWSR1/WT1 (t(11;22)) (e.g., desmoplastic small round cell tumor), translocation analysis, qualitative and quantitative, if performed

81401

Soft Tissue Sarcoma - Desmoplastic Small Round Cell Tumor, Acute Myeloid Leukemia

FGFR3 (fibroblast growth factor receptor 3) (e.g., achondroplasia, hypochondroplasia), common variants (eg, 1138G>A, 1138G>C, 1620C>A, 1620C>G)

81401

Bladder Cancer

FIP1L1/PDGFRA (del[4q12]) (e.g., imatinib-sensitive chronic eosinophilic leukemia), qualitative and quantitative, if performed

81401

Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Fusion Genes, Systemic Mastocytosis, Chronic Eosinophilic Leukemia, Myelodysplastic/Myeloproliferative Neoplasms, Gastrointestinal Stromal Tumor

FOXO1/PAX3 (t(2;13)) (e.g., alveolar rhabdomyosarcoma), translocation analysis, qualitative and quantitative, if performed

81401

Soft Tissue Sarcoma - Alveolar Rhabdomyosarcoma

FOXO1/PAX7 (t(1;13)) (e.g., alveolar rhabdomyosarcoma), translocation analysis, qualitative and quantitative, if performed

81401

Soft Tissue Sarcoma - Alveolar Rhabdomyosarcoma

FUS/DDIT3 (t(12;16)) (e.g., myxoid liposarcoma), translocation analysis, qualitative, and quantitative, if performed

81401

Soft Tissue Sarcoma - Myxoid/Round Cell Liposarcoma

IGH@/BCL2 (t(14;18)) (e.g., follicular lymphoma), translocation and analysis; single breakpoint (e.g.) major breakpoint region [MBR] or minor cluster region [mcr]), qualitative or quantitative

81401

Follicular Lymphoma, High Grade B-Cell Lymphoma

MLL/MLLT3 (t(9;11)) (e.g., acute myeloid leukemia) translocation analysis, qualitative and quantitative, if performed

81401

Acute Myeloid Leukemia

MUTYH (mutY homolog [E.coli]) (e.g., MYH-associated polyposis), common variants (e.g., Y165C, G382D)

81401

Colorectal Carcinoma

NPM1/ALK (t(2;5)) (e.g., anaplastic large cell lymphoma), translocation analysis

81401

Non-Small Cell Lung Cancer

 

PRAME (preferentially expressed antigen in melanoma)(e.g., melanoma), expression analysis

81401

Uveal Melanoma

RUNX1/RUNX1T1 (t(8;21)) (e.g., acute myeloid leukemia) translocation analysis, qualitative and quantitative, if performed

81401

Acute Myeloid Leukemia

SS18/SSX1 (t(X;18)) (e.g., synovial sarcoma), translocation analysis, qualitative and quantitative, if performed

81401

Soft Tissue Sarcoma - Synovial Sarcoma

SS18/SSX2 (t(X;18)) (e.g., synovial sarcoma), translocation analysis, qualitative and quantitative, if performed

81401

Soft Tissue Sarcoma - Synovial Sarcoma

Chromosome 1p-/19q- (e.g., glial tumors), deletion analysis

81402

Adult Glioma: Oligodendroglioma

COL1A1/PDGFB (t(17;22)) (e.g., dermatofibrosarcoma protuberans), translocation analysis, multiple breakpoints, qualitative, and quantitative, if performed

81402

Soft Tissue Sarcoma - Dermatofibrosarcoma Protuberans

TRD@ (T cell antigen receptor, delta) (e.g., leukemia and lymphoma), gene rearrangement analysis, evaluation to detect abnormal clonal population

81402

Myelodysplastic Syndromes, Myeloid/Lymphoid Neoplasms with Eosinophilia and TK Fusion Genes

CTNNB1 (catenin [cadherin-associated protein], beta 1, 88kDa) (e.g., desmoid tumors), targeted sequence analysis (e.g., exon 3)

81403

Adult Medulloblastoma, Soft Tissue Sarcoma - Desmoid Fibromatosis

 

DNMT3A (DNA [cytosine-5-]-methyltransferase 3 alpha) (e.g., acute myeloid leukemia), targeted sequence analysis (e.g., exon 23)

81403

Chronic Myeloid Leukemia, Myelodysplastic Syndromes

EPCAM (epithelial cell adhesion molecule) (e.g., Lynch syndrome), duplication/deletion analysis

81403

Myelodysplastic Syndromes, Hereditary Cancer Testing Criteria: Breast Cancer, Ovarian Cancer, Pancreatic Cancer, and Lynch syndrome

FGFR3 (fibroblast growth factor receptor 3) (e.g., isolated craniosynostosis), targeted sequence analysis (e.g., exon 7)

(For targeted sequence analysis of multiple FGFR3 exons, use 81404)

81403

Bladder Cancer

UBA1 (ubiquitin-like modifier activating enzyme 1) (e.g., spinal muscular atrophy, X-linked), targeted sequence analysis (e.g., exon 15)

81403

Myelodysplastic Syndromes

VHL (von Hippel-Lindau tumor suppressor) (e.g., von Hippel-Lindau familial cancer syndrome), deletion/duplication analysis

81403

Central Nervous System Cancers - Primary Spinal Cord Tumors, Malignant Peritoneal Mesothelioma, Malignant Pleural Mesothelioma, Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors -Pheochromocytoma/Paraganglioma, Neuroendocrine and Adrenal Tumors - Well-Differentiated Grade 3 Neuroendocrine Tumors, Von Hippel-Lindau Syndrome, Hereditary Renal Cell Carcinoma

CDKN2A (cyclin-dependent kinase inhibitor 2A) (e.g., CDKN2A-related cutaneous malignant melanoma, familial atypical mole-malignant melanoma syndrome), full gene sequence

81404

Ampullary Adenocarcinoma, Malignant Peritoneal Mesothelioma, Malignant Pleural Mesothelioma, Cutaneous Melanoma, Neuroendocrine and Adrenal Tumors - Well-Differentiated Grade 3 Neuroendocrine Tumors, Pancreatic Adenocarcinoma, Soft Tissue Sarcoma - Malignant Peripheral Nerve Sheath Tumor, Acute Myeloid Leukemia with BCR-ABL1, B-Lymphoblastic Leukemia/Lymphoma, T-Lymphoblastic Leukemia/Lymphoma, Hereditary Cancer Testing Criteria: Breast Cancer and Ovarian Cancer

FGFR2 (fibroblast growth factor receptor 2) (e.g., craniosynostosis, Apert syndrome, Crouzon syndrome), targeted sequence analysis (e.g., exons 8, 10)

81404

Bladder Cancer

FGFR3 (fibroblast growth factor receptor 3) (e.g., achondroplasia, hypochondroplasia), targeted sequence analysis (e.g., exons 8, 11, 12, 13)

81404

Bladder Cancer

HRAS (v-Ha-ras Harvey rat sarcoma viral oncogene homolog) (e.g., Costello syndrome), full gene sequence

81404

Salivary Gland Tumors

MEN1 (multiple endocrine neoplasia I) (e.g., multiple endocrine neoplasia type 1, Wermer syndrome), duplication/deletion analysis

81404

Adrenal Gland Tumors, Multiple Endocrine Neoplasia, Type 1, Neuroendocrine Tumors of the Gastrointestinal Tract (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors -Lung and Thymus, Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors - Well-Differentiated Grade 3 Neuroendocrine Tumors

RAF1 (v-raf-1 murine leukemia viral oncogene homolog 1) (e.g., LEOPARD syndrome), targeted sequence analysis (e.g,, exons 7, 12, 14, 17)

81404

Erdheim-Chester Disease,

Langerhans Cell Histiocytosis,

Rosai-Dorfman Disease

RET (ret proto-oncogene) (e.g., multiple endocrine neoplasia, type 2B and familial medullary thyroid carcinoma), common variants (e.g., M918T, 2647_2648delinsTT, A883F)

81404

Ampullary Adenocarcinoma, Extrahepatic Cholangiocarcinoma, Intrahepatic Cholangiocarcinoma, Gallbladder Cancer, Erdheim-Chester Disease, Langerhans Cell Histiocytosis, Rosai-Dorfman Disease, Multiple Endocrine Neoplasia, Type 2B, Neuroendocrine and Adrenal Tumors -Pheochromocytoma/Paraganglioma, Pancreatic Adenocarcinoma, Medullary Thyroid Cancer

SDHC (succinate dehydrogenase complex, subunit C, integral membrane protein, 15kDa) (e.g., hereditary paraganglioma-pheochromocytoma syndrome), duplication/deletion analysis

81404

Neuroendocrine and Adrenal Tumors -Pheochromocytoma/Paraganglioma, Soft Tissue Sarcoma - Carney-Stratakis Syndrome (Gastric Gastrointestinal Stromal Tumor and Paraganglioma), Hereditary Renal Cell Carcinoma

SDHD (succinate dehydrogenase complex, subunit D, integral membrane protein) (e.g., hereditary paraganglioma), full gene sequence

81404

Neuroendocrine and Adrenal Tumors - Pheochromocytoma/Paraganglioma, Soft Tissue Sarcoma - Carney-Stratakis syndrome (Gastric Gastrointestinal Stromal Tumor and Paraganglioma), Hereditary Renal Cell Carcinoma

STK11 (serine/threonine kinase 11) (e.g., Peutz-Jeghers syndrome), duplication/deletion analysis

81404

Ampullary Adenocarcinoma, Pancreatic Adenocarcinoma, Hereditary Cancer Testing Criteria: Breast Cancer, Ovarian Cancer, Pancreatic Cancer, and Peutz-Jeghers Syndrome

VHL (von Hippel-Lindau tumor suppressor) (e.g., von Hippel-Lindau familial cancer syndrome), full gene sequence

81404

Central Nervous System Cancers - Primary Spinal Cord Tumors, Malignant Peritoneal Mesothelioma, Malignant Pleural Mesothelioma, Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors -Pheochromocytoma/Paraganglioma, Neuroendocrine and Adrenal Tumors - Well-Differentiated Grade 3 Neuroendocrine Tumors, Von Hippel-Lindau Syndrome, Hereditary Renal Cell Carcinoma

ZEB2 (zinc finger E-box binding homeobox 2) (e.g., Mowat-Wilson syndrome), duplication/deletion analysis

81404

Acute Myeloid Leukemia - Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN)

FH (fumarate hydratase) (e.g., fumarate hydratase deficiency, hereditary leiomyomatosis with renal cell cancer), full gene sequence

81405

Hereditary Renal Cell Carcinoma

KRAS (Kirsten rat sarcoma viral oncogene homolog) (e.g., Noonan syndrome), full gene sequence

81405

Ampullary Adenocarcinoma, Chronic Myeloid Leukemia, Colon Cancer, Rectal Cancer, Erdheim-Chester Disease, Langerhans Cell Histiocytosis, Rosai-Dorfman Disease, Myelodysplastic Syndromes, Myeloproliferative Neoplasms, Non-Small Cell Lung Cancer, Pancreatic Adenocarcinoma, Soft Tissue Sarcoma - Embryonal Rhabdomyosarcoma, Juvenile Myelomonocytic Leukemia

MEN1 (multiple endocrine neoplasia I) (e.g., multiple endocrine neoplasia type 1, Wermer syndrome), full gene sequence

81405

Adrenal Gland Tumors, Multiple Endocrine Neoplasia, Type 1, Neuroendocrine Tumors of the Gastrointestinal Tract (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors -Lung and Thymus, Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors - Well-Differentiated Grade 3 Neuroendocrine Tumors

NF2 (neurofibromin 2 [merlin]) (e.g., neurofibromatosis, type 2), duplication/deletion analysis

81405

Malignant Peritoneal Mesothelioma, Malignant Pleural Mesothelioma

RET (ret proto-oncogene) (e.g., multiple endocrine neoplasia, type 2A and familial medullary thyroid carcinoma), targeted sequence analysis (e.g., exons 10, 11, 13-16)

81405

Ampullary Adenocarcinoma, Extrahepatic Cholangiocarcinoma, Intrahepatic Cholangiocarcinoma, Gallbladder Cancer, Erdheim-Chester Disease, Langerhans Cell Histiocytosis, Rosai-Dorfman Disease, Multiple Endocrine Neoplasia, Type 2A, Neuroendocrine and Adrenal Tumors -Pheochromocytoma/Paraganglioma, Pancreatic Adenocarcinoma, Medullary Thyroid Cancer

RPS19 (ribosomal protein S19) (e.g., Diamond-Blackfan anemia), full gene sequence

81405

Myelodysplastic Syndromes

SDHB (succinate dehydrogenase complex, subunit B, iron sulfur) (e.g., hereditary paraganglioma), full gene sequence

81405

Gastrointestinal Stromal Tumors (GIST),

Neuroendocrine and Adrenal Tumors - Pheochromocytoma/Paraganglioma, Soft Tissue Sarcoma - Carney-Stratakis syndrome (Gastric GIST and Paraganglioma), Hereditary Renal Cell Carcinoma

SDHC (succinate dehydrogenase complex, subunit C, integral membrane protein, 15kDa) (e.g., hereditary paraganglioma-pheochromocytoma syndrome), full gene sequence

81405

Neuroendocrine and Adrenal Tumors - Pheochromocytoma/Paraganglioma, Soft Tissue Sarcoma - Carney-Stratakis Syndrome (Gastric Gastrointestinal Stromal Tumor and Paraganglioma), Hereditary Renal Cell Carcinoma

SMAD4 (SMAD family member 4) (e.g., hemorrhagic telangiectasia syndrome, juvenile polyposis), duplication/deletion analysis

81405

Hereditary Cancer Testing Criteria: Juvenile Polyposis Syndrome

STAT3 (signal transducer and activator of transcription 3 [acute-phase response factor]) (e.g., autosomal dominant hyper-IgE syndrome), targeted sequence analysis (e.g., exons 12, 13, 14, 16, 17, 20, 21)

81405

Myelodysplastic Syndromes, T-Cell Lymphomas - Hepatosplenic T-Cell Lymphoma, T-Cell Lymphomas - T-Cell Large Granular Lymphocytic Leukemia

STK11 (serine/threonine kinase 11) (e.g., Peutz-Jeghers syndrome), full gene sequence

81405

Ampullary Adenocarcinoma, Pancreatic Adenocarcinoma, Hereditary Cancer Testing Criteria: Breast Cancer, Ovarian Cancer, Pancreatic Cancer, and Peutz-Jeghers Syndrome

TSC1 (tuberous sclerosis 1) (e.g., tuberous sclerosis), duplication/deletion analysis

81405

Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors - Well-Differentiated Grade 3 Neuroendocrine Tumors, Uterine Sarcoma, Encapsulated Glioma, Hereditary Renal Cell Carcinoma

WT1 (Wilms tumor 1) (e.g., Denys-Drash syndrome, familial Wilms tumor), full gene sequence

81405

Chronic Myeloid Leukemia, Malignant Peritoneal Mesothelioma, Malignant Pleural Mesothelioma, Myelodysplastic Syndromes, Wilms Tumor (Nephroblastoma), Acute Myeloid Leukemia

ZEB2 (zinc finger E-box binding homeobox 2) (e.g., Mowat-Wilson syndrome), full gene sequence

81405

Acute Myeloid Leukemia - Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN)

BRAF (B-Raf proto-oncogene, serine/threonine kinase) (e.g., Noonan syndrome), full gene sequence

81406

Ampullary Adenocarcinoma,

B-Cell Lymphomas - Splenic Marginal Zone Lymphoma, Adult Gliomas, Chronic Myeloid Leukemia, Gastrointestinal Stromal Tumors (GIST), Extrahepatic Cholangiocarcinoma, Intrahepatic Cholangiocarcinoma, Gallbladder Cancer, Erdheim-Chester Disease, Langerhans Cell Histiocytosis, Rosai-Dorfman Disease, Pancreatic Adenocarcinoma

BTK (Bruton agammaglobulinemia tyrosine kinase) (e.g., X-linked agammaglobulinemia), full gene sequence

81406

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

CDH1 (cadherin 1, type 1, E-cadherin [epithelial]) (e.g., hereditary diffuse gastric cancer), full gene sequence

81406

Gastric Cancer, Hereditary Cancer Testing Criteria: Breast Cancer and Ovarian Cancer

MAP2K1 (mitogen-activated protein kinase 1) (e.g., cardiofaciocutaneous syndrome), full gene sequence

81406

Erdheim-Chester Disease, Langerhans Cell Histiocytosis, Rosai-Dorfman Disease

MAP2K2 (mitogen-activated protein kinase 2) (e.g., cardiofaciocutaneous syndrome), full gene sequence

81406

Erdheim-Chester Disease, Langerhans Cell Histiocytosis, Rosai-Dorfman Disease

MUTYH (mutY homolog [E. coli]) (e.g., MYH-associated polyposis), full gene sequence

81406

Colorectal Carcinoma

NF2 (neurofibromin 2 [merlin]) (e.g., neurofibromatosis, type 2), full gene sequence

81406

Malignant Peritoneal Mesothelioma, Malignant Pleural Mesothelioma

PTPN11 (protein tyrosine phosphatase, non-receptor type 11) (e.g., Noonan syndrome, LEOPARD syndrome), full gene sequence

81406

Chronic Myeloid Leukemia, Myelodysplastic Syndromes,

Juvenile Myelomonocytic Leukemia

RAF1 (v-raf-1 murine leukemia viral oncogene homolog 1) (e.g., LEOPARD syndrome), full gene sequence

81406

Erdheim-Chester Disease, Langerhans Cell Histiocytosis, Rosai-Dorfman Disease

RET (ret proto-oncogene) (e.g., Hirschsprung disease), full gene sequence

81406

Ampullary Adenocarcinoma, Extrahepatic Cholangiocarcinoma, Intrahepatic Cholangiocarcinoma, Gallbladder Cancer, Erdheim-Chester Disease, Langerhans Cell Histiocytosis, Rosai-Dorfman Disease, Multiple Endocrine Neoplasia, Type 2A and B, Neuroendocrine and Adrenal Tumors - Pheochromocytoma/Paraganglioma, Pancreatic Adenocarcinoma, Medullary Thyroid Cancer

SDHA (succinate dehydrogenase complex, subunit A, flavoprotein [Fp]) (e.g., Leigh syndrome, mitochondrial complex II deficiency), full gene sequence

81406

Neuroendocrine and Adrenal Tumors - Pheochromocytoma/Paraganglioma, Hereditary Renal Cell Carcinoma

SMAD4 (SMAD family member 4) (e.g., hemorrhagic telangiectasia syndrome, juvenile polyposis), full gene sequence

81406

Hereditary Cancer Testing Criteria: Juvenile Polyposis Syndrome

TSC1 (tuberous sclerosis 1) (e.g., tuberous sclerosis), full gene sequence

81406

Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors - Well-Differentiated Grade 3 Neuroendocrine Tumors, Uterine Sarcoma, Encapsulated Glioma, Hereditary Renal Cell Carcinoma

TSC2 (tuberous sclerosis 2) (e.g., tuberous sclerosis), duplication/deletion analysis

81406

Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors - Well-Differentiated Grade 3 Neuroendocrine Tumors, Uterine Sarcoma, Encapsulated Glioma, Hereditary Renal Cell Carcinoma

NOTCH1 (notch 1) (e.g., aortic valve disease), full gene sequence

81407

T-Lymphoblastic Leukemia/Lymphoma

TSC2 (tuberous sclerosis 2) (e.g., tuberous sclerosis), full gene sequence

81407

Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors - Well-Differentiated Grade 3 Neuroendocrine Tumors, Uterine Sarcoma, Encapsulated Glioma, Hereditary Renal Cell Carcinoma

ATM (ataxia telangiectasia mutated) (e.g., ataxia telangiectasia), full gene sequence

81408

Ampullary Adenocarcinoma, Pancreatic Adenocarcinoma, Prostate Cancer, Hereditary Cancer Testing Criteria: Breast Cancer, Ovarian Cancer, and Pancreatic Cancer

NF1 (neurofibromin 1) (e.g, neurofibromatosis, type 1), full gene sequence

81408

Gastrointestinal Stromal Tumors (GIST), Myelodysplastic Syndromes, Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2), Neuroendocrine and Adrenal Tumors - Pheochromocytoma/Paraganglioma, Neuroendocrine and Adrenal Tumors - Well-Differentiated Grade 3 Neuroendocrine Tumors, Soft Tissue Sarcoma - Embryonal rhabdomyosarcoma, Soft Tissue Sarcoma - Malignant peripheral nerve sheath tumor, Neurofibroma, Chronic Myelomonocytic Leukemia, Juvenile Myelomonocytic Leukemia, Hereditary Cancer Testing Criteria: Breast Cancer and Ovarian Cancer


Utilization Parameters

Genetic testing for hereditary cancer syndromes is considered germline testing, and therefore only permitted once per beneficiary’s lifecycle.

The following tests are germline tests:

  • 81202
  • 81215
  • 81217
  • 81293
  • 81296
  • 81299
  • 81308
  • 81318
  • 81322
  • 81353
  • 81432
  • 81433
  • 81435
  • 81436
  • 81437
  • 81438
  • 0101U
  • 0102U
  • 0103U
  • 0129U
  • 0130U
  • 0131U
  • 0132U
  • 0133U
  • 0134U
  • 0135U
  • 0162U
  • 0238U

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code(s) must describe the service performed.
  4. The medical record must demonstrate that the treating clinician who is responsible for the management of the patient’s cancer or substantiated suspicion of cancer is the same person as the ordering clinician.
  5. The medical record must include documentation to support an established diagnosis of cancer or a substantiated suspicion of cancer.
  6. The medical record must include documentation of how the test results will directly impact the management of the patient’s specific medical problem.
  7. The medical record must clearly document the communication and discussion of pre-test and post-test counseling and the risk associated with genetic testing.
  8. The medical record from the ordering clinician must clearly indicate all tests that are to be performed.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(9 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
Code Description
81162 Brca1&2 gen full seq dup/del
81163 Brca1&2 gene full seq alys
81164 Brca1&2 gen ful dup/del alys
81165 Brca1 gene full seq alys
81166 Brca1 gene full dup/del alys
81167 Brca2 gene full dup/del alys
81212 Brca1&2 185&5385&6174 vrnt
81216 Brca2 gene full seq alys
0138U Brca1 brca2 mrna seq alys

Group 2

(3 Codes)
Group 2 Paragraph

N/A

Group 2 Codes
Code Description
81215 Brca1 gene known famil vrnt
81217 Brca2 gene known famil vrnt
81308 Palb2 gene known famil vrnt

Group 3

(4 Codes)
Group 3 Paragraph

N/A

Group 3 Codes
Code Description
81432 Hrdtry brst ca-rlatd dsordrs
0102U Hered brst ca rltd do 17 gen
0129U Hered brst ca rltd do panel
0131U Hered brst ca rltd do pnl 13

Group 4

(1 Code)
Group 4 Paragraph

N/A

Group 4 Codes
Code Description
81433 Hrdtry brst ca-rlatd dsordrs

Group 5

(8 Codes)
Group 5 Paragraph

N/A

Group 5 Codes
Code Description
81202 Apc gene known fam variants
81288 Mlh1 gene
81435 Hereditary colon ca dsordrs
81436 Hereditary colon ca dsordrs
0101U Hered colon ca do 15 genes
0130U Hered colon ca do mrna pnl
0162U Hered colon ca trgt mrna pnl
0238U Onc lnch syn gen dna seq aly

Group 6

(2 Codes)
Group 6 Paragraph

N/A

Group 6 Codes
Code Description
81437 Heredtry nurondcrn tum dsrdr
81438 Heredtry nurondcrn tum dsrdr

Group 7

(8 Codes)
Group 7 Paragraph

N/A

Group 7 Codes
Code Description
81445 Tgsap so neo 5-50dna/dna&rna
81449 Tgsap so neo 5-50 rna alys
0048U Onc sld org neo dna 468 gene
0244U Onc solid orgn dna 257 genes
0250U Onc sld org neo dna 505 gene
0334U Onc sld orgn tgsa dna 84/+
0379U Tgsap sl or neo dna523&rna55
0391U Onc sld tum dna&rna 437 gen

Group 8

(2 Codes)
Group 8 Paragraph

N/A

Group 8 Codes
Code Description
81450 Tgsap hl neo 5-50dna/dna&rna
81451 Tgsap hl neo 5-50 rna alys

Group 9

(2 Codes)
Group 9 Paragraph

For ICD-10-CM diagnosis codes, see ICD-10-CM Codes that Support Medical Necessity Group 7 and Group 8 below.

Group 9 Codes
Code Description
81455 Tgsap so/hl 51/> dna/dna&rna
81456 Tgsap so/hl 51/> rna alys

Group 10

(1 Code)
Group 10 Paragraph

N/A

Group 10 Codes
Code Description
81301 Microsatellite instability

Group 11

(3 Codes)
Group 11 Paragraph

N/A

Group 11 Codes
Code Description
81261 Igh gene rearrange amp meth
81262 Igh gene rearrang dir probe
81264 Igk rearrangeabn clonal pop

Group 12

(1 Code)
Group 12 Paragraph

N/A

Group 12 Codes
Code Description
81263 Igh vari regional mutation

Group 13

(3 Codes)
Group 13 Paragraph

N/A

Group 13 Codes
Code Description
81340 Trb@ gene rearrange amplify
81341 Trb@ gene rearrange dirprobe
81342 Trg gene rearrangement anal

Group 14

(11 Codes)
Group 14 Paragraph

N/A

Group 14 Codes
Code Description
81209 Blm gene
81242 Fancc gene
81277 Cytogenomic neo microra alys
81415 Exome sequence analysis
81416 Exome sequence analysis
81417 Exome re-evaluation
81425 Genome sequence analysis
81426 Genome sequence analysis
81427 Genome re-evaluation
0036U Xome tum & nml spec seq alys
0329U Onc neo xome&trns seq alys

Group 15

(9 Codes)
Group 15 Paragraph

N/A

Group 15 Codes
Code Description
81518 Onc brst mrna 11 genes
81519 Oncology breast mrna
81520 Onc breast mrna 58 genes
81521 Onc breast mrna 70 genes
81522 Onc breast mrna 12 genes
81523 Onc brst mrna 70 cnt 31 gene
0009U Onc brst ca erbb2 amp/nonamp
0155U Onc brst ca dna pik3ca gene
0177U Onc brst ca dna pik3ca 11

Group 16

(4 Codes)
Group 16 Paragraph

N/A

Group 16 Codes
Code Description
81541 Onc prostate mrna 46 genes
81542 Onc prostate mrna 22 cnt gen
0047U Onc prst8 mrna 17 gene alg
0133U Hered prst8 ca rltd do 11

Group 17

(2 Codes)
Group 17 Paragraph

N/A

Group 17 Codes
Code Description
81313 Pca3/klk3 antigen
81551 Onc prostate 3 genes

Group 18

(3 Codes)
Group 18 Paragraph

N/A

Group 18 Codes
Code Description
0005U Onco prst8 3 gene ur alg
0113U Onc prst8 pca3&tmprss2-erg
0339U Onc prst8 mrna hoxc6 & dlx1

Group 19

(1 Code)
Group 19 Paragraph

N/A

Group 19 Codes
Code Description
81552 Onc uveal mlnma mrna 15 gene

Group 20

(1 Code)
Group 20 Paragraph

N/A

Group 20 Codes
Code Description
81525 Oncology colon mrna

Group 21

(2 Codes)
Group 21 Paragraph

N/A

Group 21 Codes
Code Description
81120 Idh1 common variants
81121 Idh2 common variants

Group 22

(1 Code)
Group 22 Paragraph

N/A

Group 22 Codes
Code Description
81170 Abl1 gene

Group 23

(2 Codes)
Group 23 Paragraph

N/A

Group 23 Codes
Code Description
81175 Asxl1 full gene sequence
81176 Asxl1 gene target seq alys

Group 24

(3 Codes)
Group 24 Paragraph

N/A

Group 24 Codes
Code Description
81201 Apc gene full sequence
81203 Apc gene dup/delet variants
0157U Apc mrna seq alys

Group 25

(1 Code)
Group 25 Paragraph

N/A

Group 25 Codes
Code Description
81210 Braf gene

Group 26

(1 Code)
Group 26 Paragraph

N/A

Group 26 Codes
Code Description
81218 Cebpa gene full sequence

Group 27

(3 Codes)
Group 27 Paragraph

N/A

Group 27 Codes
Code Description
81219 Calr gene com variants
81338 Mpl gene common variants
81339 Mpl gene seq alys exon 10

Group 28

(2 Codes)
Group 28 Paragraph

N/A

Group 28 Codes
Code Description
81233 Btk gene common variants
81320 Plcg2 gene common variants

Group 29

(4 Codes)
Group 29 Paragraph

N/A

Group 29 Codes
Code Description
81235 Egfr gene com variants
0179U Onc nonsm cll lng ca alys 23
0388U Onc nonsm cll lng ca 37 gen
0397U Onc nonsm cll lng ca 109

Group 30

(2 Codes)
Group 30 Paragraph

N/A

Group 30 Codes
Code Description
81236 Ezh2 gene full gene sequence
81237 Ezh2 gene common variants

Group 31

(3 Codes)
Group 31 Paragraph

N/A

Group 31 Codes
Code Description
81245 Flt3 gene
81246 Flt3 gene analysis
0046U Flt3 gene itd variants quan

Group 32

(2 Codes)
Group 32 Paragraph

N/A

Group 32 Codes
Code Description
0023U Onc aml dna detcj/nondetcj
0050U Trgt gen seq dna 194 genes

Group 33

(4 Codes)
Group 33 Paragraph

N/A

Group 33 Codes
Code Description
81270 Jak2 gene
81279 Jak2 gene trgt sequence alys
0017U Onc hmtlmf neo jak2 mut dna
0027U Jak2 gene trgt seq alys

Group 34

(1 Code)
Group 34 Paragraph

N/A

Group 34 Codes
Code Description
81272 Kit gene targeted seq analys

Group 35

(1 Code)
Group 35 Paragraph

N/A

Group 35 Codes
Code Description
81273 Kit gene analys d816 variant

Group 36

(2 Codes)
Group 36 Paragraph

N/A

Group 36 Codes
Code Description
81275 Kras gene variants exon 2
81276 Kras gene addl variants

Group 37

(1 Code)
Group 37 Paragraph

N/A

Group 37 Codes
Code Description
81287 Mgmt gene prmtr mthyltn alys

Group 38

(12 Codes)
Group 38 Paragraph

N/A

Group 38 Codes
Code Description
81292 Mlh1 gene full seq
81294 Mlh1 gene dup/delete variant
81295 Msh2 gene full seq
81297 Msh2 gene dup/delete variant
81298 Msh6 gene full seq
81300 Msh6 gene dup/delete variant
81317 Pms2 gene full seq analysis
81319 Pms2 gene dup/delet variants
0158U Mlh1 mrna seq alys
0159U Msh2 mrna seq alys
0160U Msh6 mrna seq alys
0161U Pms2 mrna seq alys

Group 39

(4 Codes)
Group 39 Paragraph

N/A

Group 39 Codes
Code Description
81293 Mlh1 gene known variants
81296 Msh2 gene known variants
81299 Msh6 gene known variants
81318 Pms2 known familial variants

Group 40

(1 Code)
Group 40 Paragraph

N/A

Group 40 Codes
Code Description
81305 Myd88 gene p.leu265pro vrnt

Group 41

(2 Codes)
Group 41 Paragraph

N/A

Group 41 Codes
Code Description
81307 Palb2 gene full gene seq
0137U Palb2 mrna seq alys

Group 42

(1 Code)
Group 42 Paragraph

N/A

Group 42 Codes
Code Description
81309 Pik3ca gene trgt seq alys

Group 43

(2 Codes)
Group 43 Paragraph

N/A

Group 43 Codes
Code Description
81310 Npm1 gene
0049U Npm1 gene analysis quan

Group 44

(1 Code)
Group 44 Paragraph

N/A

Group 44 Codes
Code Description
81311 Nras gene variants exon 2&3

Group 45

(1 Code)
Group 45 Paragraph

N/A

Group 45 Codes
Code Description
81314 Pdgfra gene

Group 46

(4 Codes)
Group 46 Paragraph

N/A

Group 46 Codes
Code Description
81321 Pten gene full sequence
81322 Pten gene known fam variant
81323 Pten gene dup/delet variant
0235U Pten full gene analysis

Group 47

(1 Code)
Group 47 Paragraph

N/A

Group 47 Codes
Code Description
81334 Runx1 gene targeted seq alys

Group 48

(1 Code)
Group 48 Paragraph

N/A

Group 48 Codes
Code Description
81345 Tert gene targeted seq alys

Group 49

(1 Code)
Group 49 Paragraph

N/A

Group 49 Codes
Code Description
81347 Sf3b1 gene common variants

Group 50

(1 Code)
Group 50 Paragraph

N/A

Group 50 Codes
Code Description
81348 Srsf2 gene common variants

Group 51

(2 Codes)
Group 51 Paragraph

N/A

Group 51 Codes
Code Description
81351 Tp53 gene full gene sequence
81352 Tp53 gene trgt sequence alys

Group 52

(1 Code)
Group 52 Paragraph

N/A

Group 52 Codes
Code Description
81353 Tp53 gene known famil vrnt

Group 53

(1 Code)
Group 53 Paragraph

N/A

Group 53 Codes
Code Description
81357 U2af1 gene common variants

Group 54

(1 Code)
Group 54 Paragraph

N/A

Group 54 Codes
Code Description
81360 Zrsr2 gene common variants

Group 55

(1 Code)
Group 55 Paragraph

N/A

Group 55 Codes
Code Description
0154U Onc urthl ca rna fgfr3 gene

Group 56

(1 Code)
Group 56 Paragraph

N/A

Group 56 Codes
Code Description
81168 Ccnd1/igh translocation alys

Group 57

(2 Codes)
Group 57 Paragraph

N/A

Group 57 Codes
Code Description
81191 Ntrk1 translocation analysis
81192 Ntrk2 translocation analysis

Group 58

(1 Code)
Group 58 Paragraph

N/A

Group 58 Codes
Code Description
81193 Ntrk3 translocation analysis

Group 59

(1 Code)
Group 59 Paragraph

N/A

Group 59 Codes
Code Description
81194 Ntrk translocation analysis

Group 60

(5 Codes)
Group 60 Paragraph

N/A

Group 60 Codes
Code Description
81206 Bcr/abl1 gene major bp
81207 Bcr/abl1 gene minor bp
81208 Bcr/abl1 gene other bp
0016U Onc hmtlmf neo rna bcr/abl1
0040U Bcr/abl1 gene major bp quan

Group 61

(1 Code)
Group 61 Paragraph

N/A

Group 61 Codes
Code Description
81278 Igh@/bcl2 translocation alys

Group 62

(2 Codes)
Group 62 Paragraph

N/A

Group 62 Codes
Code Description
81315 Pml/raralpha com breakpoints
81316 Pml/raralpha 1 breakpoint

Group 63

(3 Codes)
Group 63 Paragraph

N/A

Group 63 Codes
Code Description
0211U Onc pan-tum dna&rna gnrj seq
0297U Onc pan tum whl gen seq dna
0298U Onc pan tum whl trns seq rna

Group 64

(2 Codes)
Group 64 Paragraph

N/A

Group 64 Codes
Code Description
0103U Hered ova ca pnl 24 genes
0132U Hered ova ca rltd do pnl 17

Group 65

(1 Code)
Group 65 Paragraph

N/A

Group 65 Codes
Code Description
0134U Hered pan ca mrna pnl 18 gen

Group 66

(1 Code)
Group 66 Paragraph

N/A

Group 66 Codes
Code Description
0135U Hered gyn ca mrna pnl 12 gen

Group 67

(1 Code)
Group 67 Paragraph

N/A

Group 67 Codes
Code Description
81401 Mopath procedure level 2

Group 68

(1 Code)
Group 68 Paragraph

N/A

Group 68 Codes
Code Description
81402 Mopath procedure level 3

Group 69

(1 Code)
Group 69 Paragraph

N/A

Group 69 Codes
Code Description
81403 Mopath procedure level 4

Group 70

(1 Code)
Group 70 Paragraph

N/A

Group 70 Codes
Code Description
81404 Mopath procedure level 5

Group 71

(1 Code)
Group 71 Paragraph

N/A

Group 71 Codes
Code Description
81405 Mopath procedure level 6

Group 72

(1 Code)
Group 72 Paragraph

N/A

Group 72 Codes
Code Description
81406 Mopath procedure level 7

Group 73

(1 Code)
Group 73 Paragraph

N/A

Group 73 Codes
Code Description
81407 Mopath procedure level 8

Group 74

(2 Codes)
Group 74 Paragraph

N/A

Group 74 Codes
Code Description
81408 Mopath procedure level 9
0136U Atm mrna seq alys

Group 75

(4 Codes)
Group 75 Paragraph

N/A

Group 75 Codes
Code Description
81546 Onc thyr mrna 10,196 gen alg
0018U Onc thyr 10 microrna seq alg
0026U Onc thyr dna&mrna 112 genes
0245U Onc thyr mut alys 10 gen&37

Group 76

(1 Code)
Group 76 Paragraph

N/A

Group 76 Codes
Code Description
0204U Onc thyr mrna xprsn alys 593

Group 77

(2 Codes)
Group 77 Paragraph

N/A

Group 77 Codes
Code Description
0090U Onc cutan mlnma mrna 23 gene
0314U Onc cutan mlnma mrna 35 gene

Group 78

(1 Code)
Group 78 Paragraph

N/A

Group 78 Codes
Code Description
0364U Onc hl neo gen seq alys alg

Group 79

(1 Code)
Group 79 Paragraph

N/A

Group 79 Codes
Code Description
0326U Trgt gen seq alys pnl 83+

Group 80

(10 Codes)
Group 80 Paragraph

N/A

Group 80 Codes
Code Description
88358 Analysis tumor
88364 Insitu hybridization (fish)
88365 Insitu hybridization (fish)
88366 Insitu hybridization (fish)
88367 Insitu hybridization auto
88368 Insitu hybridization manual
88369 M/phmtrc alysishquant/semiq
88373 M/phmtrc alys ishquant/semiq
88374 M/phmtrc alys ishquant/semiq
88377 M/phmtrc alys ishquant/semiq

Group 81

(42 Codes)
Group 81 Paragraph

Non-Covered CPT Codes

Group 81 Codes
Code Description
81504 Oncology tissue of origin
81529 Onc cutan mlnma mrna 31 gene
81540 Oncology tum unknown origin
88120 Cytp urne 3-5 probes ea spec
88121 Cytp urine 3-5 probes cmptr
0006M Onc hep gene risk classifier
0007M Onc gastro 51 gene nomogram
0011M Onc prst8 ca mrna 12 gen alg
0012M Onc mrna 5 gen rsk urthl ca
0013M Onc mrna 5 gen recr urthl ca
0016M Onc bladder mrna 219 gen alg
0017M Onc dlbcl mrna 20 genes alg
0019U Onc rna tiss predict alg
0045U Onc brst dux carc is 12 gene
0069U Onc clrct microrna mir-31-3p
0089U Onc mlnma prame & linc00518
0120U Onc b cll lymphm mrna 58 gen
0153U Onc breast mrna 101 genes
0171U Trgt gen seq alys pnl dna 23
0229U Bcat1&ikzf1 prmtr mthyln aly
0262U Onc sld tum rt-pcr 7 gen
0285U Onc rsps radj cll fr dna tox
0287U Onc thyr dna&mrna 112 genes
0288U Onc lung mrna quan pcr 11&3
0296U Onc orl&/orop ca 20 mlc feat
0299U Onc pan tum whl gen opt mapg
0300U Onc pan tum whl gen seq&opt
0306U Onc mrd nxt-gnrj alys 1st
0307U Onc mrd nxt-gnrj alys sbsq
0313U Onc pncrs dna&mrna seq 74
0315U Onc cutan sq cll ca mrna 40
0317U Onc lung ca 4-prb fish assay
0331U Onc hl neo opt gen mapping
0332U Onc pan tum gen prflg 8 dna
0333U Onc lvr surveilanc hcc cfdna
0340U Onc pan ca alys mrd plasma
0343U Onc prst8 xom aly 442 sncrna
0356U Onc orop 17 dna ddpcr alg
0362U Onc pap thyr ca rna 82&10
0363U Onc urthl mrna 5 gen alg
0368U Onc clrct ca mut&mthyltn mrk
0398U Gi baret esph dna mthyln aly
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(62 Codes)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81162, 81163, 81164, 81165, 81166, 81167, 81212, 81216, and 0138U.

Group 1 Codes
Code Description
C22.1 Intrahepatic bile duct carcinoma
C23 Malignant neoplasm of gallbladder
C24.0 Malignant neoplasm of extrahepatic bile duct
C24.1 Malignant neoplasm of ampulla of Vater
C24.8 Malignant neoplasm of overlapping sites of biliary tract
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C45.0* Mesothelioma of pleura
C45.1* Mesothelioma of peritoneum
C48.1* Malignant neoplasm of specified parts of peritoneum
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
C61 Malignant neoplasm of prostate
C94.6 Myelodysplastic disease, not elsewhere classified
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: ICD-10 codes C45.0 and C45.1 may only be reported with CPT codes 81167 and 81216.

*Note: Use ICD-10 code C48.1 for Primary Peritoneal Carcinoma.

Group 2

(46 Codes)
Group 2 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81215, 81217, and 81308.

Group 2 Codes
Code Description
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C48.1* Malignant neoplasm of specified parts of peritoneum
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
C61 Malignant neoplasm of prostate
Group 2 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code C48.1 for Primary Peritoneal Carcinoma.

Group 3

(38 Codes)
Group 3 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81432, 0102U, 0129U, and 0131U.

Group 3 Codes
Code Description
C48.1* Malignant neoplasm of specified parts of peritoneum
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
Group 3 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code C48.1 for Primary Peritoneal Carcinoma.

Group 4

(45 Codes)
Group 4 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81433.

Group 4 Codes
Code Description
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C48.1* Malignant neoplasm of specified parts of peritoneum
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
Group 4 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code C48.1 for Primary Peritoneal Carcinoma.

Group 5

(19 Codes)
Group 5 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM code supports medical necessity and provides coverage for CPT codes: 81202, 81288, 81435, 81436, 0101U, 0130U, 0162U, and 0238U.

 

Group 5 Codes
Code Description
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C54.0 Malignant neoplasm of isthmus uteri
C54.1 Malignant neoplasm of endometrium
C54.2 Malignant neoplasm of myometrium
C54.3 Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri

Group 6

(9 Codes)
Group 6 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81437 and 81438.

Group 6 Codes
Code Description
C74.11* Malignant neoplasm of medulla of right adrenal gland
C74.12* Malignant neoplasm of medulla of left adrenal gland
C75.5 Malignant neoplasm of aortic body and other paraganglia
D35.01* Benign neoplasm of right adrenal gland
D35.02* Benign neoplasm of left adrenal gland
D35.6 Benign neoplasm of aortic body and other paraganglia
D44.11* Neoplasm of uncertain behavior of right adrenal gland
D44.12* Neoplasm of uncertain behavior of left adrenal gland
D44.7 Neoplasm of uncertain behavior of aortic body and other paraganglia
Group 6 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C74.11, C74.12, D35.01, D35.02, D44.11, or D44.12 for pheochromocytoma.

Group 7

(463 Codes)
Group 7 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81445, 81449, 81455, 81456, 0048U, 0244U, 0250U, 0334U, 0379U and 0391U.

 

Group 7 Codes
Code Description
C00.0 Malignant neoplasm of external upper lip
C00.1 Malignant neoplasm of external lower lip
C00.3 Malignant neoplasm of upper lip, inner aspect
C00.4 Malignant neoplasm of lower lip, inner aspect
C00.6 Malignant neoplasm of commissure of lip, unspecified
C00.8 Malignant neoplasm of overlapping sites of lip
C01 Malignant neoplasm of base of tongue
C02.0 Malignant neoplasm of dorsal surface of tongue
C02.1 Malignant neoplasm of border of tongue
C02.2 Malignant neoplasm of ventral surface of tongue
C02.4 Malignant neoplasm of lingual tonsil
C02.8 Malignant neoplasm of overlapping sites of tongue
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum
C04.0 Malignant neoplasm of anterior floor of mouth
C04.1 Malignant neoplasm of lateral floor of mouth
C04.8 Malignant neoplasm of overlapping sites of floor of mouth
C05.0 Malignant neoplasm of hard palate
C05.1 Malignant neoplasm of soft palate
C05.2 Malignant neoplasm of uvula
C05.8 Malignant neoplasm of overlapping sites of palate
C06.0 Malignant neoplasm of cheek mucosa
C06.1 Malignant neoplasm of vestibule of mouth
C06.2 Malignant neoplasm of retromolar area
C06.89 Malignant neoplasm of overlapping sites of other parts of mouth
C07 Malignant neoplasm of parotid gland
C08.0 Malignant neoplasm of submandibular gland
C08.1 Malignant neoplasm of sublingual gland
C09.0 Malignant neoplasm of tonsillar fossa
C09.1 Malignant neoplasm of tonsillar pillar (anterior) (posterior)
C09.8 Malignant neoplasm of overlapping sites of tonsil
C09.9* Malignant neoplasm of tonsil, unspecified
C10.0 Malignant neoplasm of vallecula
C10.1 Malignant neoplasm of anterior surface of epiglottis
C10.2 Malignant neoplasm of lateral wall of oropharynx
C10.3 Malignant neoplasm of posterior wall of oropharynx
C10.4 Malignant neoplasm of branchial cleft
C10.8 Malignant neoplasm of overlapping sites of oropharynx
C11.0 Malignant neoplasm of superior wall of nasopharynx
C11.1 Malignant neoplasm of posterior wall of nasopharynx
C11.2 Malignant neoplasm of lateral wall of nasopharynx
C11.3 Malignant neoplasm of anterior wall of nasopharynx
C11.8 Malignant neoplasm of overlapping sites of nasopharynx
C12 Malignant neoplasm of pyriform sinus
C13.0 Malignant neoplasm of postcricoid region
C13.1 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
C13.2 Malignant neoplasm of posterior wall of hypopharynx
C13.8 Malignant neoplasm of overlapping sites of hypopharynx
C14.2 Malignant neoplasm of Waldeyer's ring
C14.8 Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx
C15.3 Malignant neoplasm of upper third of esophagus
C15.4 Malignant neoplasm of middle third of esophagus
C15.5 Malignant neoplasm of lower third of esophagus
C15.8 Malignant neoplasm of overlapping sites of esophagus
C16.0 Malignant neoplasm of cardia
C16.1 Malignant neoplasm of fundus of stomach
C16.2 Malignant neoplasm of body of stomach
C16.3 Malignant neoplasm of pyloric antrum
C16.4 Malignant neoplasm of pylorus
C16.8 Malignant neoplasm of overlapping sites of stomach
C17.0 Malignant neoplasm of duodenum
C17.1 Malignant neoplasm of jejunum
C17.2 Malignant neoplasm of ileum
C17.3 Meckel's diverticulum, malignant
C17.8 Malignant neoplasm of overlapping sites of small intestine
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C22.0 Liver cell carcinoma
C22.1 Intrahepatic bile duct carcinoma
C22.2 Hepatoblastoma
C22.3 Angiosarcoma of liver
C22.4 Other sarcomas of liver
C22.7 Other specified carcinomas of liver
C23 Malignant neoplasm of gallbladder
C24.0 Malignant neoplasm of extrahepatic bile duct
C24.1 Malignant neoplasm of ampulla of Vater
C24.8 Malignant neoplasm of overlapping sites of biliary tract
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C26.1 Malignant neoplasm of spleen
C30.0 Malignant neoplasm of nasal cavity
C30.1 Malignant neoplasm of middle ear
C31.0 Malignant neoplasm of maxillary sinus
C31.1 Malignant neoplasm of ethmoidal sinus
C31.2 Malignant neoplasm of frontal sinus
C31.3 Malignant neoplasm of sphenoid sinus
C31.8 Malignant neoplasm of overlapping sites of accessory sinuses
C32.0 Malignant neoplasm of glottis
C32.1 Malignant neoplasm of supraglottis
C32.2 Malignant neoplasm of subglottis
C32.3 Malignant neoplasm of laryngeal cartilage
C32.8 Malignant neoplasm of overlapping sites of larynx
C33 Malignant neoplasm of trachea
C34.01 Malignant neoplasm of right main bronchus
C34.02 Malignant neoplasm of left main bronchus
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung
C37 Malignant neoplasm of thymus
C38.0 Malignant neoplasm of heart
C38.1 Malignant neoplasm of anterior mediastinum
C38.2 Malignant neoplasm of posterior mediastinum
C38.4 Malignant neoplasm of pleura
C38.8 Malignant neoplasm of overlapping sites of heart, mediastinum and pleura
C40.01* Malignant neoplasm of scapula and long bones of right upper limb
C40.02* Malignant neoplasm of scapula and long bones of left upper limb
C40.11* Malignant neoplasm of short bones of right upper limb
C40.12* Malignant neoplasm of short bones of left upper limb
C40.21* Malignant neoplasm of long bones of right lower limb
C40.22* Malignant neoplasm of long bones of left lower limb
C40.31* Malignant neoplasm of short bones of right lower limb
C40.32* Malignant neoplasm of short bones of left lower limb
C40.81* Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb
C40.82* Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb
C41.0* Malignant neoplasm of bones of skull and face
C41.1* Malignant neoplasm of mandible
C41.2* Malignant neoplasm of vertebral column
C41.3* Malignant neoplasm of ribs, sternum and clavicle
C41.4* Malignant neoplasm of pelvic bones, sacrum and coccyx
C43.0 Malignant melanoma of lip
C43.111 Malignant melanoma of right upper eyelid, including canthus
C43.112 Malignant melanoma of right lower eyelid, including canthus
C43.121 Malignant melanoma of left upper eyelid, including canthus
C43.122 Malignant melanoma of left lower eyelid, including canthus
C43.21 Malignant melanoma of right ear and external auricular canal
C43.22 Malignant melanoma of left ear and external auricular canal
C43.31 Malignant melanoma of nose
C43.39 Malignant melanoma of other parts of face
C43.4 Malignant melanoma of scalp and neck
C43.51 Malignant melanoma of anal skin
C43.52 Malignant melanoma of skin of breast
C43.59 Malignant melanoma of other part of trunk
C43.61 Malignant melanoma of right upper limb, including shoulder
C43.62 Malignant melanoma of left upper limb, including shoulder
C43.71 Malignant melanoma of right lower limb, including hip
C43.72 Malignant melanoma of left lower limb, including hip
C43.8 Malignant melanoma of overlapping sites of skin
C44.01 Basal cell carcinoma of skin of lip
C44.02 Squamous cell carcinoma of skin of lip
C44.09 Other specified malignant neoplasm of skin of lip
C44.1121 Basal cell carcinoma of skin of right upper eyelid, including canthus
C44.1122 Basal cell carcinoma of skin of right lower eyelid, including canthus
C44.1191 Basal cell carcinoma of skin of left upper eyelid, including canthus
C44.1192 Basal cell carcinoma of skin of left lower eyelid, including canthus
C44.1221 Squamous cell carcinoma of skin of right upper eyelid, including canthus
C44.1222 Squamous cell carcinoma of skin of right lower eyelid, including canthus
C44.1291 Squamous cell carcinoma of skin of left upper eyelid, including canthus
C44.1292 Squamous cell carcinoma of skin of left lower eyelid, including canthus
C44.1321 Sebaceous cell carcinoma of skin of right upper eyelid, including canthus
C44.1322 Sebaceous cell carcinoma of skin of right lower eyelid, including canthus
C44.1391 Sebaceous cell carcinoma of skin of left upper eyelid, including canthus
C44.1392 Sebaceous cell carcinoma of skin of left lower eyelid, including canthus
C44.1921 Other specified malignant neoplasm of skin of right upper eyelid, including canthus
C44.1922 Other specified malignant neoplasm of skin of right lower eyelid, including canthus
C44.1991 Other specified malignant neoplasm of skin of left upper eyelid, including canthus
C44.1992 Other specified malignant neoplasm of skin of left lower eyelid, including canthus
C44.212 Basal cell carcinoma of skin of right ear and external auricular canal
C44.219 Basal cell carcinoma of skin of left ear and external auricular canal
C44.222 Squamous cell carcinoma of skin of right ear and external auricular canal
C44.229 Squamous cell carcinoma of skin of left ear and external auricular canal
C44.292 Other specified malignant neoplasm of skin of right ear and external auricular canal
C44.299 Other specified malignant neoplasm of skin of left ear and external auricular canal
C44.311 Basal cell carcinoma of skin of nose
C44.319 Basal cell carcinoma of skin of other parts of face
C44.321 Squamous cell carcinoma of skin of nose
C44.329 Squamous cell carcinoma of skin of other parts of face
C44.391 Other specified malignant neoplasm of skin of nose
C44.399 Other specified malignant neoplasm of skin of other parts of face
C44.41 Basal cell carcinoma of skin of scalp and neck
C44.42 Squamous cell carcinoma of skin of scalp and neck
C44.49 Other specified malignant neoplasm of skin of scalp and neck
C44.510 Basal cell carcinoma of anal skin
C44.511 Basal cell carcinoma of skin of breast
C44.519 Basal cell carcinoma of skin of other part of trunk
C44.520 Squamous cell carcinoma of anal skin
C44.521 Squamous cell carcinoma of skin of breast
C44.529 Squamous cell carcinoma of skin of other part of trunk
C44.590 Other specified malignant neoplasm of anal skin
C44.591 Other specified malignant neoplasm of skin of breast
C44.599 Other specified malignant neoplasm of skin of other part of trunk
C44.612 Basal cell carcinoma of skin of right upper limb, including shoulder
C44.619 Basal cell carcinoma of skin of left upper limb, including shoulder
C44.622 Squamous cell carcinoma of skin of right upper limb, including shoulder
C44.629 Squamous cell carcinoma of skin of left upper limb, including shoulder
C44.692 Other specified malignant neoplasm of skin of right upper limb, including shoulder
C44.699 Other specified malignant neoplasm of skin of left upper limb, including shoulder
C44.712 Basal cell carcinoma of skin of right lower limb, including hip
C44.719 Basal cell carcinoma of skin of left lower limb, including hip
C44.722 Squamous cell carcinoma of skin of right lower limb, including hip
C44.729 Squamous cell carcinoma of skin of left lower limb, including hip
C44.792 Other specified malignant neoplasm of skin of right lower limb, including hip
C44.799 Other specified malignant neoplasm of skin of left lower limb, including hip
C44.81 Basal cell carcinoma of overlapping sites of skin
C44.82 Squamous cell carcinoma of overlapping sites of skin
C44.89 Other specified malignant neoplasm of overlapping sites of skin
C45.0 Mesothelioma of pleura
C45.1 Mesothelioma of peritoneum
C45.2 Mesothelioma of pericardium
C45.7 Mesothelioma of other sites
C46.0 Kaposi's sarcoma of skin
C46.1 Kaposi's sarcoma of soft tissue
C46.2 Kaposi's sarcoma of palate
C46.3 Kaposi's sarcoma of lymph nodes
C46.4 Kaposi's sarcoma of gastrointestinal sites
C46.51 Kaposi's sarcoma of right lung
C46.52 Kaposi's sarcoma of left lung
C46.7 Kaposi's sarcoma of other sites
C47.0* Malignant neoplasm of peripheral nerves of head, face and neck
C47.11* Malignant neoplasm of peripheral nerves of right upper limb, including shoulder
C47.12* Malignant neoplasm of peripheral nerves of left upper limb, including shoulder
C47.21* Malignant neoplasm of peripheral nerves of right lower limb, including hip
C47.22* Malignant neoplasm of peripheral nerves of left lower limb, including hip
C47.3* Malignant neoplasm of peripheral nerves of thorax
C47.4* Malignant neoplasm of peripheral nerves of abdomen
C47.5* Malignant neoplasm of peripheral nerves of pelvis
C47.8* Malignant neoplasm of overlapping sites of peripheral nerves and autonomic nervous system
C48.0* Malignant neoplasm of retroperitoneum
C48.1* Malignant neoplasm of specified parts of peritoneum
C48.8* Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C49.0* Malignant neoplasm of connective and soft tissue of head, face and neck
C49.11* Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder
C49.12* Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder
C49.21* Malignant neoplasm of connective and soft tissue of right lower limb, including hip
C49.22* Malignant neoplasm of connective and soft tissue of left lower limb, including hip
C49.3* Malignant neoplasm of connective and soft tissue of thorax
C49.4* Malignant neoplasm of connective and soft tissue of abdomen
C49.5* Malignant neoplasm of connective and soft tissue of pelvis
C49.8* Malignant neoplasm of overlapping sites of connective and soft tissue
C49.A1 Gastrointestinal stromal tumor of esophagus
C49.A2 Gastrointestinal stromal tumor of stomach
C49.A3 Gastrointestinal stromal tumor of small intestine
C49.A4 Gastrointestinal stromal tumor of large intestine
C49.A5 Gastrointestinal stromal tumor of rectum
C49.A9 Gastrointestinal stromal tumor of other sites
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C51.0 Malignant neoplasm of labium majus
C51.1 Malignant neoplasm of labium minus
C51.2 Malignant neoplasm of clitoris
C51.8 Malignant neoplasm of overlapping sites of vulva
C52 Malignant neoplasm of vagina
C53.0 Malignant neoplasm of endocervix
C53.1 Malignant neoplasm of exocervix
C53.8 Malignant neoplasm of overlapping sites of cervix uteri
C54.0 Malignant neoplasm of isthmus uteri
C54.1 Malignant neoplasm of endometrium
C54.2 Malignant neoplasm of myometrium
C54.3 Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
C57.11 Malignant neoplasm of right broad ligament
C57.12 Malignant neoplasm of left broad ligament
C57.21 Malignant neoplasm of right round ligament
C57.22 Malignant neoplasm of left round ligament
C57.3 Malignant neoplasm of parametrium
C57.7 Malignant neoplasm of other specified female genital organs
C57.8 Malignant neoplasm of overlapping sites of female genital organs
C58 Malignant neoplasm of placenta
C60.0 Malignant neoplasm of prepuce
C60.1 Malignant neoplasm of glans penis
C60.2 Malignant neoplasm of body of penis
C60.8 Malignant neoplasm of overlapping sites of penis
C61 Malignant neoplasm of prostate
C62.01 Malignant neoplasm of undescended right testis
C62.02 Malignant neoplasm of undescended left testis
C62.11 Malignant neoplasm of descended right testis
C62.12 Malignant neoplasm of descended left testis
C63.01 Malignant neoplasm of right epididymis
C63.02 Malignant neoplasm of left epididymis
C63.11 Malignant neoplasm of right spermatic cord
C63.12 Malignant neoplasm of left spermatic cord
C63.2 Malignant neoplasm of scrotum
C63.7 Malignant neoplasm of other specified male genital organs
C63.8 Malignant neoplasm of overlapping sites of male genital organs
C64.1* Malignant neoplasm of right kidney, except renal pelvis
C64.2* Malignant neoplasm of left kidney, except renal pelvis
C65.1 Malignant neoplasm of right renal pelvis
C65.2 Malignant neoplasm of left renal pelvis
C66.1 Malignant neoplasm of right ureter
C66.2 Malignant neoplasm of left ureter
C67.0 Malignant neoplasm of trigone of bladder
C67.1 Malignant neoplasm of dome of bladder
C67.2 Malignant neoplasm of lateral wall of bladder
C67.3 Malignant neoplasm of anterior wall of bladder
C67.4 Malignant neoplasm of posterior wall of bladder
C67.5 Malignant neoplasm of bladder neck
C67.6 Malignant neoplasm of ureteric orifice
C67.7 Malignant neoplasm of urachus
C67.8 Malignant neoplasm of overlapping sites of bladder
C68.0 Malignant neoplasm of urethra
C68.1 Malignant neoplasm of paraurethral glands
C68.8 Malignant neoplasm of overlapping sites of urinary organs
C69.01 Malignant neoplasm of right conjunctiva
C69.02 Malignant neoplasm of left conjunctiva
C69.11 Malignant neoplasm of right cornea
C69.12 Malignant neoplasm of left cornea
C69.21 Malignant neoplasm of right retina
C69.22 Malignant neoplasm of left retina
C69.31* Malignant neoplasm of right choroid
C69.32* Malignant neoplasm of left choroid
C69.41* Malignant neoplasm of right ciliary body
C69.42* Malignant neoplasm of left ciliary body
C69.51 Malignant neoplasm of right lacrimal gland and duct
C69.52 Malignant neoplasm of left lacrimal gland and duct
C69.61 Malignant neoplasm of right orbit
C69.62 Malignant neoplasm of left orbit
C69.81 Malignant neoplasm of overlapping sites of right eye and adnexa
C69.82 Malignant neoplasm of overlapping sites of left eye and adnexa
C70.0 Malignant neoplasm of cerebral meninges
C70.1 Malignant neoplasm of spinal meninges
C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles
C71.1 Malignant neoplasm of frontal lobe
C71.2 Malignant neoplasm of temporal lobe
C71.3 Malignant neoplasm of parietal lobe
C71.4 Malignant neoplasm of occipital lobe
C71.5 Malignant neoplasm of cerebral ventricle
C71.6 Malignant neoplasm of cerebellum
C71.7 Malignant neoplasm of brain stem
C71.8 Malignant neoplasm of overlapping sites of brain
C72.0 Malignant neoplasm of spinal cord
C72.1 Malignant neoplasm of cauda equina
C72.21 Malignant neoplasm of right olfactory nerve
C72.22 Malignant neoplasm of left olfactory nerve
C72.31 Malignant neoplasm of right optic nerve
C72.32 Malignant neoplasm of left optic nerve
C72.41 Malignant neoplasm of right acoustic nerve
C72.42 Malignant neoplasm of left acoustic nerve
C72.59 Malignant neoplasm of other cranial nerves
C73 Malignant neoplasm of thyroid gland
C74.01 Malignant neoplasm of cortex of right adrenal gland
C74.02 Malignant neoplasm of cortex of left adrenal gland
C74.11* Malignant neoplasm of medulla of right adrenal gland
C74.12* Malignant neoplasm of medulla of left adrenal gland
C75.0 Malignant neoplasm of parathyroid gland
C75.1 Malignant neoplasm of pituitary gland
C75.2 Malignant neoplasm of craniopharyngeal duct
C75.3 Malignant neoplasm of pineal gland
C75.4 Malignant neoplasm of carotid body
C75.5 Malignant neoplasm of aortic body and other paraganglia
C75.8 Malignant neoplasm with pluriglandular involvement, unspecified
C7A.010* Malignant carcinoid tumor of the duodenum
C7A.011* Malignant carcinoid tumor of the jejunum
C7A.012* Malignant carcinoid tumor of the ileum
C7A.020* Malignant carcinoid tumor of the appendix
C7A.021* Malignant carcinoid tumor of the cecum
C7A.022* Malignant carcinoid tumor of the ascending colon
C7A.023* Malignant carcinoid tumor of the transverse colon
C7A.024* Malignant carcinoid tumor of the descending colon
C7A.025* Malignant carcinoid tumor of the sigmoid colon
C7A.026* Malignant carcinoid tumor of the rectum
C7A.090* Malignant carcinoid tumor of the bronchus and lung
C7A.091* Malignant carcinoid tumor of the thymus
C7A.092* Malignant carcinoid tumor of the stomach
C7A.093 Malignant carcinoid tumor of the kidney
C7A.098* Malignant carcinoid tumors of other sites
C7A.1 Malignant poorly differentiated neuroendocrine tumors
C7A.8* Other malignant neuroendocrine tumors
C7B.02* Secondary carcinoid tumors of liver
C7B.03* Secondary carcinoid tumors of bone
C7B.04* Secondary carcinoid tumors of peritoneum
C7B.09* Secondary carcinoid tumors of other sites
C7B.1 Secondary Merkel cell carcinoma
C7B.8* Other secondary neuroendocrine tumors
C78.01 Secondary malignant neoplasm of right lung
C78.02 Secondary malignant neoplasm of left lung
C78.1 Secondary malignant neoplasm of mediastinum
C78.2 Secondary malignant neoplasm of pleura
C78.39 Secondary malignant neoplasm of other respiratory organs
C78.4 Secondary malignant neoplasm of small intestine
C78.5 Secondary malignant neoplasm of large intestine and rectum
C78.6 Secondary malignant neoplasm of retroperitoneum and peritoneum
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
C78.89 Secondary malignant neoplasm of other digestive organs
C79.01 Secondary malignant neoplasm of right kidney and renal pelvis
C79.02 Secondary malignant neoplasm of left kidney and renal pelvis
C79.11 Secondary malignant neoplasm of bladder
C79.19 Secondary malignant neoplasm of other urinary organs
C79.2 Secondary malignant neoplasm of skin
C79.31 Secondary malignant neoplasm of brain
C79.32 Secondary malignant neoplasm of cerebral meninges
C79.49 Secondary malignant neoplasm of other parts of nervous system
C79.51 Secondary malignant neoplasm of bone
C79.52 Secondary malignant neoplasm of bone marrow
C79.61 Secondary malignant neoplasm of right ovary
C79.62 Secondary malignant neoplasm of left ovary
C79.63 Secondary malignant neoplasm of bilateral ovaries
C79.71 Secondary malignant neoplasm of right adrenal gland
C79.72 Secondary malignant neoplasm of left adrenal gland
C79.81 Secondary malignant neoplasm of breast
C79.82 Secondary malignant neoplasm of genital organs
C79.89 Secondary malignant neoplasm of other specified sites
C80.2 Malignant neoplasm associated with transplanted organ
D35.01* Benign neoplasm of right adrenal gland
D35.02* Benign neoplasm of left adrenal gland
D35.6 Benign neoplasm of aortic body and other paraganglia
D44.11* Neoplasm of uncertain behavior of right adrenal gland
D44.12* Neoplasm of uncertain behavior of left adrenal gland
D44.7 Neoplasm of uncertain behavior of aortic body and other paraganglia
E31.21 Multiple endocrine neoplasia [MEN] type I
E31.22 Multiple endocrine neoplasia [MEN] type IIA
E31.23 Multiple endocrine neoplasia [MEN] type IIB
Q85.01 Neurofibromatosis, type 1
Q85.02 Neurofibromatosis, type 2
Q85.1 Tuberous sclerosis
Q85.81 PTEN tumor syndrome
Q85.82 Other Cowden syndrome
Q85.83 Von Hippel-Lindau syndrome
Q85.89* Other phakomatoses, not elsewhere classified
Group 7 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code C09.9 for Malignant neoplasm of faucial tonsils or palatine tonsils.

*Note: Use ICD-10 codes C40.01, C40.02, C40.11, C40.12, C40.21, C40.22, C40.31, C40.32, C40.81, C40.82, C41.0, C41.1, C41.2, C41.3 or C41.4 for Bone Cancer Chondrosarcoma, Chordoma, Osteosarcoma, or Ewing Sarcoma.

*Note: Use ICD-10 codes C47.0, C47.11, C47.12, C47.21, C47.22, C47.3, C47.4, C47.5, C47.8, C48.0, C48.1, C48.8, C49.0, C49.11, C49.12, C49.21, C49.22, C49.3, C49.4, C49.5, or C49.8 for Soft Tissue Sarcoma.

*Note: Use ICD-10 code C48.1 for Primary Peritoneal Carcinoma.

*Note: Use ICD-10 codes C64.1 or C64.2 for Wilms Tumor or Renal Cell Carcinoma.

*Note: Use ICD-10 codes C69.31, C69.32, C69.41, or C69.42 for Uveal Melanoma.

*Note: Use ICD-10 codes C74.11, C74.12, D35.01, D35.02, D44.11, or D44.12 for Pheochromocytoma. C74.11 and C74.12 can also be used for other types of cancer of the medulla of the adrenal gland.

*Note: Use ICD-10 codes C7A.010, C7A.011, C7A.012, C7A.020, C7A.021, C7A.022, C7A.023, C7A.024, C7A.025, C7A.026, C7A.090, C7A.091, C7A.092, C7A.098, C7A.8, C7B.02, C7B.03, C7B.04, C7B.09, or C7B.8 for Neuroendocrine Tumors of the Gastrointestinal Tract (Well-Differentiated Grade 1/2), Lung, or Thymus.

*Note: Use ICD-10 codes C7A.098, C7A.8, C7B.02, C7B.03, C7B.04, C7B.09 or C7B.8 for Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2).

*Note: Use ICD-10 codes C7A.8 or C7B.8 for Well-Differentiated Grade 3 Neuroendocrine Tumors.

*Note: Use ICD-10 code Q85.89 for Peutz-Jeghers Syndrome.

Group 8

(365 Codes)
Group 8 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81450, 81451, 81455, and 81456.

Group 8 Codes
Code Description
C7B.01* Secondary carcinoid tumors of distant lymph nodes
C77.0 Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck
C77.1 Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes
C77.2 Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes
C77.3 Secondary and unspecified malignant neoplasm of axilla and upper limb lymph nodes
C77.4 Secondary and unspecified malignant neoplasm of inguinal and lower limb lymph nodes
C77.5 Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes
C77.8 Secondary and unspecified malignant neoplasm of lymph nodes of multiple regions
C81.01 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.02 Nodular lymphocyte predominant Hodgkin lymphoma, intrathoracic lymph nodes
C81.03 Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes
C81.04 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.05 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.06 Nodular lymphocyte predominant Hodgkin lymphoma, intrapelvic lymph nodes
C81.07 Nodular lymphocyte predominant Hodgkin lymphoma, spleen
C81.08 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of multiple sites
C81.09 Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites
C81.11 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.12 Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes
C81.13 Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes
C81.14 Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.15 Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.16 Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes
C81.17 Nodular sclerosis Hodgkin lymphoma, spleen
C81.18 Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites
C81.19 Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites
C81.21 Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.22 Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes
C81.23 Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes
C81.24 Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.25 Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.26 Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes
C81.27 Mixed cellularity Hodgkin lymphoma, spleen
C81.28 Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites
C81.29 Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites
C81.31 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.32 Lymphocyte depleted Hodgkin lymphoma, intrathoracic lymph nodes
C81.33 Lymphocyte depleted Hodgkin lymphoma, intra-abdominal lymph nodes
C81.34 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.35 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.36 Lymphocyte depleted Hodgkin lymphoma, intrapelvic lymph nodes
C81.37 Lymphocyte depleted Hodgkin lymphoma, spleen
C81.38 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of multiple sites
C81.39 Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites
C81.41 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.42 Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes
C81.43 Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes
C81.44 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.45 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.46 Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes
C81.47 Lymphocyte-rich Hodgkin lymphoma, spleen
C81.48 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites
C81.49 Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites
C81.71 Other Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.72 Other Hodgkin lymphoma, intrathoracic lymph nodes
C81.73 Other Hodgkin lymphoma, intra-abdominal lymph nodes
C81.74 Other Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.75 Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.76 Other Hodgkin lymphoma, intrapelvic lymph nodes
C81.77 Other Hodgkin lymphoma, spleen
C81.78 Other Hodgkin lymphoma, lymph nodes of multiple sites
C81.79 Other Hodgkin lymphoma, extranodal and solid organ sites
C82.01 Follicular lymphoma grade I, lymph nodes of head, face, and neck
C82.02 Follicular lymphoma grade I, intrathoracic lymph nodes
C82.03 Follicular lymphoma grade I, intra-abdominal lymph nodes
C82.04 Follicular lymphoma grade I, lymph nodes of axilla and upper limb
C82.05 Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb
C82.06 Follicular lymphoma grade I, intrapelvic lymph nodes
C82.07 Follicular lymphoma grade I, spleen
C82.08 Follicular lymphoma grade I, lymph nodes of multiple sites
C82.09 Follicular lymphoma grade I, extranodal and solid organ sites
C82.11 Follicular lymphoma grade II, lymph nodes of head, face, and neck
C82.12 Follicular lymphoma grade II, intrathoracic lymph nodes
C82.13 Follicular lymphoma grade II, intra-abdominal lymph nodes
C82.14 Follicular lymphoma grade II, lymph nodes of axilla and upper limb
C82.15 Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb
C82.16 Follicular lymphoma grade II, intrapelvic lymph nodes
C82.17 Follicular lymphoma grade II, spleen
C82.18 Follicular lymphoma grade II, lymph nodes of multiple sites
C82.19 Follicular lymphoma grade II, extranodal and solid organ sites
C82.31 Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck
C82.32 Follicular lymphoma grade IIIa, intrathoracic lymph nodes
C82.33 Follicular lymphoma grade IIIa, intra-abdominal lymph nodes
C82.34 Follicular lymphoma grade IIIa, lymph nodes of axilla and upper limb
C82.35 Follicular lymphoma grade IIIa, lymph nodes of inguinal region and lower limb
C82.36 Follicular lymphoma grade IIIa, intrapelvic lymph nodes
C82.37 Follicular lymphoma grade IIIa, spleen
C82.38 Follicular lymphoma grade IIIa, lymph nodes of multiple sites
C82.39 Follicular lymphoma grade IIIa, extranodal and solid organ sites
C82.41 Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck
C82.42 Follicular lymphoma grade IIIb, intrathoracic lymph nodes
C82.43 Follicular lymphoma grade IIIb, intra-abdominal lymph nodes
C82.44 Follicular lymphoma grade IIIb, lymph nodes of axilla and upper limb
C82.45 Follicular lymphoma grade IIIb, lymph nodes of inguinal region and lower limb
C82.46 Follicular lymphoma grade IIIb, intrapelvic lymph nodes
C82.47 Follicular lymphoma grade IIIb, spleen
C82.48 Follicular lymphoma grade IIIb, lymph nodes of multiple sites
C82.49 Follicular lymphoma grade IIIb, extranodal and solid organ sites
C82.51 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck
C82.52 Diffuse follicle center lymphoma, intrathoracic lymph nodes
C82.53 Diffuse follicle center lymphoma, intra-abdominal lymph nodes
C82.54 Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb
C82.55 Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.56 Diffuse follicle center lymphoma, intrapelvic lymph nodes
C82.57 Diffuse follicle center lymphoma, spleen
C82.58 Diffuse follicle center lymphoma, lymph nodes of multiple sites
C82.59 Diffuse follicle center lymphoma, extranodal and solid organ sites
C82.61* Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck
C82.62* Cutaneous follicle center lymphoma, intrathoracic lymph nodes
C82.63* Cutaneous follicle center lymphoma, intra-abdominal lymph nodes
C82.64* Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb
C82.65* Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.66* Cutaneous follicle center lymphoma, intrapelvic lymph nodes
C82.67* Cutaneous follicle center lymphoma, spleen
C82.68* Cutaneous follicle center lymphoma, lymph nodes of multiple sites
C82.69* Cutaneous follicle center lymphoma, extranodal and solid organ sites
C82.81 Other types of follicular lymphoma, lymph nodes of head, face, and neck
C82.82 Other types of follicular lymphoma, intrathoracic lymph nodes
C82.83 Other types of follicular lymphoma, intra-abdominal lymph nodes
C82.84 Other types of follicular lymphoma, lymph nodes of axilla and upper limb
C82.85 Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb
C82.86 Other types of follicular lymphoma, intrapelvic lymph nodes
C82.87 Other types of follicular lymphoma, spleen
C82.88 Other types of follicular lymphoma, lymph nodes of multiple sites
C82.89 Other types of follicular lymphoma, extranodal and solid organ sites
C83.01 Small cell B-cell lymphoma, lymph nodes of head, face, and neck
C83.02 Small cell B-cell lymphoma, intrathoracic lymph nodes
C83.03 Small cell B-cell lymphoma, intra-abdominal lymph nodes
C83.04 Small cell B-cell lymphoma, lymph nodes of axilla and upper limb
C83.05 Small cell B-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.06 Small cell B-cell lymphoma, intrapelvic lymph nodes
C83.07 Small cell B-cell lymphoma, spleen
C83.08 Small cell B-cell lymphoma, lymph nodes of multiple sites
C83.09 Small cell B-cell lymphoma, extranodal and solid organ sites
C83.11 Mantle cell lymphoma, lymph nodes of head, face, and neck
C83.12 Mantle cell lymphoma, intrathoracic lymph nodes
C83.13 Mantle cell lymphoma, intra-abdominal lymph nodes
C83.14 Mantle cell lymphoma, lymph nodes of axilla and upper limb
C83.15 Mantle cell lymphoma, lymph nodes of inguinal region and lower limb
C83.16 Mantle cell lymphoma, intrapelvic lymph nodes
C83.17 Mantle cell lymphoma, spleen
C83.18 Mantle cell lymphoma, lymph nodes of multiple sites
C83.19 Mantle cell lymphoma, extranodal and solid organ sites
C83.31* Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck
C83.32* Diffuse large B-cell lymphoma, intrathoracic lymph nodes
C83.33* Diffuse large B-cell lymphoma, intra-abdominal lymph nodes
C83.34* Diffuse large B-cell lymphoma, lymph nodes of axilla and upper limb
C83.35* Diffuse large B-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.36* Diffuse large B-cell lymphoma, intrapelvic lymph nodes
C83.37* Diffuse large B-cell lymphoma, spleen
C83.38* Diffuse large B-cell lymphoma, lymph nodes of multiple sites
C83.39* Diffuse large B-cell lymphoma, extranodal and solid organ sites
C83.51 Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck
C83.52 Lymphoblastic (diffuse) lymphoma, intrathoracic lymph nodes
C83.53 Lymphoblastic (diffuse) lymphoma, intra-abdominal lymph nodes
C83.54 Lymphoblastic (diffuse) lymphoma, lymph nodes of axilla and upper limb
C83.55 Lymphoblastic (diffuse) lymphoma, lymph nodes of inguinal region and lower limb
C83.56 Lymphoblastic (diffuse) lymphoma, intrapelvic lymph nodes
C83.57 Lymphoblastic (diffuse) lymphoma, spleen
C83.58 Lymphoblastic (diffuse) lymphoma, lymph nodes of multiple sites
C83.59 Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites
C83.71* Burkitt lymphoma, lymph nodes of head, face, and neck
C83.72* Burkitt lymphoma, intrathoracic lymph nodes
C83.73* Burkitt lymphoma, intra-abdominal lymph nodes
C83.74* Burkitt lymphoma, lymph nodes of axilla and upper limb
C83.75* Burkitt lymphoma, lymph nodes of inguinal region and lower limb
C83.76* Burkitt lymphoma, intrapelvic lymph nodes
C83.77* Burkitt lymphoma, spleen
C83.78* Burkitt lymphoma, lymph nodes of multiple sites
C83.79* Burkitt lymphoma, extranodal and solid organ sites
C83.81* Other non-follicular lymphoma, lymph nodes of head, face, and neck
C83.82* Other non-follicular lymphoma, intrathoracic lymph nodes
C83.83* Other non-follicular lymphoma, intra-abdominal lymph nodes
C83.84* Other non-follicular lymphoma, lymph nodes of axilla and upper limb
C83.85* Other non-follicular lymphoma, lymph nodes of inguinal region and lower limb
C83.86* Other non-follicular lymphoma, intrapelvic lymph nodes
C83.87* Other non-follicular lymphoma, spleen
C83.88* Other non-follicular lymphoma, lymph nodes of multiple sites
C83.89* Other non-follicular lymphoma, extranodal and solid organ sites
C84.01 Mycosis fungoides, lymph nodes of head, face, and neck
C84.02 Mycosis fungoides, intrathoracic lymph nodes
C84.03 Mycosis fungoides, intra-abdominal lymph nodes
C84.04 Mycosis fungoides, lymph nodes of axilla and upper limb
C84.05 Mycosis fungoides, lymph nodes of inguinal region and lower limb
C84.06 Mycosis fungoides, intrapelvic lymph nodes
C84.07 Mycosis fungoides, spleen
C84.08 Mycosis fungoides, lymph nodes of multiple sites
C84.09 Mycosis fungoides, extranodal and solid organ sites
C84.11 Sezary disease, lymph nodes of head, face, and neck
C84.12 Sezary disease, intrathoracic lymph nodes
C84.13 Sezary disease, intra-abdominal lymph nodes
C84.14 Sezary disease, lymph nodes of axilla and upper limb
C84.15 Sezary disease, lymph nodes of inguinal region and lower limb
C84.16 Sezary disease, intrapelvic lymph nodes
C84.17 Sezary disease, spleen
C84.18 Sezary disease, lymph nodes of multiple sites
C84.19 Sezary disease, extranodal and solid organ sites
C84.41* Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of head, face, and neck
C84.42* Peripheral T-cell lymphoma, not elsewhere classified, intrathoracic lymph nodes
C84.43* Peripheral T-cell lymphoma, not elsewhere classified, intra-abdominal lymph nodes
C84.44* Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of axilla and upper limb
C84.45* Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of inguinal region and lower limb
C84.46* Peripheral T-cell lymphoma, not elsewhere classified, intrapelvic lymph nodes
C84.47* Peripheral T-cell lymphoma, not elsewhere classified, spleen
C84.48* Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of multiple sites
C84.49* Peripheral T-cell lymphoma, not elsewhere classified, extranodal and solid organ sites
C84.61* Anaplastic large cell lymphoma, ALK-positive, lymph nodes of head, face, and neck
C84.62* Anaplastic large cell lymphoma, ALK-positive, intrathoracic lymph nodes
C84.63* Anaplastic large cell lymphoma, ALK-positive, intra-abdominal lymph nodes
C84.64* Anaplastic large cell lymphoma, ALK-positive, lymph nodes of axilla and upper limb
C84.65* Anaplastic large cell lymphoma, ALK-positive, lymph nodes of inguinal region and lower limb
C84.66* Anaplastic large cell lymphoma, ALK-positive, intrapelvic lymph nodes
C84.67* Anaplastic large cell lymphoma, ALK-positive, spleen
C84.68* Anaplastic large cell lymphoma, ALK-positive, lymph nodes of multiple sites
C84.69* Anaplastic large cell lymphoma, ALK-positive, extranodal and solid organ sites
C84.71* Anaplastic large cell lymphoma, ALK-negative, lymph nodes of head, face, and neck
C84.72* Anaplastic large cell lymphoma, ALK-negative, intrathoracic lymph nodes
C84.73* Anaplastic large cell lymphoma, ALK-negative, intra-abdominal lymph nodes
C84.74* Anaplastic large cell lymphoma, ALK-negative, lymph nodes of axilla and upper limb
C84.75* Anaplastic large cell lymphoma, ALK-negative, lymph nodes of inguinal region and lower limb
C84.76* Anaplastic large cell lymphoma, ALK-negative, intrapelvic lymph nodes
C84.77* Anaplastic large cell lymphoma, ALK-negative, spleen
C84.78* Anaplastic large cell lymphoma, ALK-negative, lymph nodes of multiple sites
C84.79* Anaplastic large cell lymphoma, ALK-negative, extranodal and solid organ sites
C84.7A* Anaplastic large cell lymphoma, ALK-negative, breast
C84.A1 Cutaneous T-cell lymphoma, unspecified lymph nodes of head, face, and neck
C84.A2 Cutaneous T-cell lymphoma, unspecified, intrathoracic lymph nodes
C84.A3 Cutaneous T-cell lymphoma, unspecified, intra-abdominal lymph nodes
C84.A4 Cutaneous T-cell lymphoma, unspecified, lymph nodes of axilla and upper limb
C84.A5 Cutaneous T-cell lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C84.A6 Cutaneous T-cell lymphoma, unspecified, intrapelvic lymph nodes
C84.A7 Cutaneous T-cell lymphoma, unspecified, spleen
C84.A8 Cutaneous T-cell lymphoma, unspecified, lymph nodes of multiple sites
C84.A9 Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites
C84.Z1 Other mature T/NK-cell lymphomas, lymph nodes of head, face, and neck
C84.Z2 Other mature T/NK-cell lymphomas, intrathoracic lymph nodes
C84.Z3 Other mature T/NK-cell lymphomas, intra-abdominal lymph nodes
C84.Z4 Other mature T/NK-cell lymphomas, lymph nodes of axilla and upper limb
C84.Z5 Other mature T/NK-cell lymphomas, lymph nodes of inguinal region and lower limb
C84.Z6 Other mature T/NK-cell lymphomas, intrapelvic lymph nodes
C84.Z7* Other mature T/NK-cell lymphomas, spleen
C84.Z8 Other mature T/NK-cell lymphomas, lymph nodes of multiple sites
C84.Z9* Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C85.21 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck
C85.22 Mediastinal (thymic) large B-cell lymphoma, intrathoracic lymph nodes
C85.23 Mediastinal (thymic) large B-cell lymphoma, intra-abdominal lymph nodes
C85.24 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of axilla and upper limb
C85.25 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of inguinal region and lower limb
C85.26 Mediastinal (thymic) large B-cell lymphoma, intrapelvic lymph nodes
C85.27 Mediastinal (thymic) large B-cell lymphoma, spleen
C85.28 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of multiple sites
C85.29 Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites
C85.81* Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck
C85.82* Other specified types of non-Hodgkin lymphoma, intrathoracic lymph nodes
C85.83* Other specified types of non-Hodgkin lymphoma, intra-abdominal lymph nodes
C85.84* Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb
C85.85* Other specified types of non-Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C85.86* Other specified types of non-Hodgkin lymphoma, intrapelvic lymph nodes
C85.87* Other specified types of non-Hodgkin lymphoma, spleen
C85.88* Other specified types of non-Hodgkin lymphoma, lymph nodes of multiple sites
C85.89* Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites
C86.0* Extranodal NK/T-cell lymphoma, nasal type
C86.1 Hepatosplenic T-cell lymphoma
C86.2* Enteropathy-type (intestinal) T-cell lymphoma
C86.3 Subcutaneous panniculitis-like T-cell lymphoma
C86.4* Blastic NK-cell lymphoma
C86.5* Angioimmunoblastic T-cell lymphoma
C86.6 Primary cutaneous CD30-positive T-cell proliferations
C88.0 Waldenstrom macroglobulinemia
C88.2 Heavy chain disease
C88.3 Immunoproliferative small intestinal disease
C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]
C88.8 Other malignant immunoproliferative diseases
C90.00 Multiple myeloma not having achieved remission
C90.02 Multiple myeloma in relapse
C90.10 Plasma cell leukemia not having achieved remission
C90.12 Plasma cell leukemia in relapse
C90.20 Extramedullary plasmacytoma not having achieved remission
C90.22 Extramedullary plasmacytoma in relapse
C90.30 Solitary plasmacytoma not having achieved remission
C90.32 Solitary plasmacytoma in relapse
C91.00 Acute lymphoblastic leukemia not having achieved remission
C91.02 Acute lymphoblastic leukemia, in relapse
C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission
C91.12 Chronic lymphocytic leukemia of B-cell type in relapse
C91.30 Prolymphocytic leukemia of B-cell type not having achieved remission
C91.32 Prolymphocytic leukemia of B-cell type, in relapse
C91.40 Hairy cell leukemia not having achieved remission
C91.42 Hairy cell leukemia, in relapse
C91.50 Adult T-cell lymphoma/leukemia (HTLV-1-associated) not having achieved remission
C91.52 Adult T-cell lymphoma/leukemia (HTLV-1-associated), in relapse
C91.60 Prolymphocytic leukemia of T-cell type not having achieved remission
C91.62 Prolymphocytic leukemia of T-cell type, in relapse
C91.A0 Mature B-cell leukemia Burkitt-type not having achieved remission
C91.A2 Mature B-cell leukemia Burkitt-type, in relapse
C91.Z0* Other lymphoid leukemia not having achieved remission
C91.Z2* Other lymphoid leukemia, in relapse
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.30 Myeloid sarcoma, not having achieved remission
C92.32 Myeloid sarcoma, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C92.Z0 Other myeloid leukemia not having achieved remission
C92.Z2 Other myeloid leukemia, in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse
C93.10* Chronic myelomonocytic leukemia not having achieved remission
C93.12* Chronic myelomonocytic leukemia, in relapse
C93.30 Juvenile myelomonocytic leukemia, not having achieved remission
C93.32 Juvenile myelomonocytic leukemia, in relapse
C93.Z0 Other monocytic leukemia, not having achieved remission
C93.Z2 Other monocytic leukemia, in relapse
C94.00 Acute erythroid leukemia, not having achieved remission
C94.02 Acute erythroid leukemia, in relapse
C94.20 Acute megakaryoblastic leukemia not having achieved remission
C94.22 Acute megakaryoblastic leukemia, in relapse
C94.30 Mast cell leukemia not having achieved remission
C94.32 Mast cell leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
C94.80* Other specified leukemias not having achieved remission
C94.82* Other specified leukemias, in relapse
C96.0 Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis
C96.21 Aggressive systemic mastocytosis
C96.22 Mast cell sarcoma
C96.29 Other malignant mast cell neoplasm
C96.4 Sarcoma of dendritic cells (accessory cells)
C96.5 Multifocal and unisystemic Langerhans-cell histiocytosis
C96.6 Unifocal Langerhans-cell histiocytosis
C96.A Histiocytic sarcoma
C96.Z* Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.01 Cutaneous mastocytosis
D47.02 Systemic mastocytosis
D47.09 Other mast cell neoplasms of uncertain behavior
D47.1 Chronic myeloproliferative disease
D47.2 Monoclonal gammopathy
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D47.Z1 Post-transplant lymphoproliferative disorder (PTLD)
D47.Z2 Castleman disease
D47.Z9 Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue
D72.18 Eosinophilia in diseases classified elsewhere
D75.81 Myelofibrosis
D76.3* Other histiocytosis syndromes
Group 8 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code C7B.01 for Neuroendocrine Tumors of the Pancreas (Well-Differentiated Grade 1/2), of the Gastrointestinal Tract (Well-Differentiated Grade 1/2), Lung, or Thymus.

*Note: Use ICD-10 codes C82.61-C82.69 or C83.81-C83.89 for Primary Cutaneous B-Cell Lymphomas.

*Note: Use ICD-10 codes C83.31-C83.39, C83.71-C83.79, C83.81-C83.89 or C85.81-C85.89 for AIDS-Related B-Cell Lymphomas.

*Note: Use ICD-10 codes C83.31-C83.39 for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma - Histologic Transformation (Richter's) to Diffuse Large B-cell Lymphoma.

*Note: Use ICD-10 codes C84.41-C84.49, C84.61-C84.69, C84.71-C84.79, C84.7A, C86.2, or C86.5 for Peripheral T-Cell Lymphomas.

*Note: Use ICD-10 codes C84.Z7, C84.Z9 or C86.0 for Extranodal NK/T-Cell Lymphomas.

*Note: Use ICD-10 codes C85.81-C85.86 or C85.88 for Nodal Marginal Zone Lymphoma.

*Note: Use ICD-10 code C85.87 for Splenic Marginal Zone Lymphoma.

*Note: Use ICD-10 code C86.4 for Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN).

*Note: Use ICD-10 codes C91.Z0 or C91.Z2 for T-Cell Large Granular Lymphocytic Leukemia.

*Note: Use ICD-10 codes C94.80, C94.82 or C96.Z for Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Fusion Genes.

*Note: Use ICD-10 code D76.3 for Erdheim-Chester Disease or Rosai-Dorfman Disease.

*Note: Use ICD-10 codes C93.10 or C93.12 with D72.18 for Chronic Eosinophilic Leukemia.

Group 9

(178 Codes)
Group 9 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81301.

Group 9 Codes
Code Description
C00.0 Malignant neoplasm of external upper lip
C00.1 Malignant neoplasm of external lower lip
C00.3 Malignant neoplasm of upper lip, inner aspect
C00.4 Malignant neoplasm of lower lip, inner aspect
C00.6 Malignant neoplasm of commissure of lip, unspecified
C00.8 Malignant neoplasm of overlapping sites of lip
C01 Malignant neoplasm of base of tongue
C02.0 Malignant neoplasm of dorsal surface of tongue
C02.1 Malignant neoplasm of border of tongue
C02.2 Malignant neoplasm of ventral surface of tongue
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum
C04.0 Malignant neoplasm of anterior floor of mouth
C04.1 Malignant neoplasm of lateral floor of mouth
C04.8 Malignant neoplasm of overlapping sites of floor of mouth
C05.0 Malignant neoplasm of hard palate
C05.1 Malignant neoplasm of soft palate
C05.2 Malignant neoplasm of uvula
C05.8 Malignant neoplasm of overlapping sites of palate
C06.0 Malignant neoplasm of cheek mucosa
C06.1 Malignant neoplasm of vestibule of mouth
C06.2 Malignant neoplasm of retromolar area
C06.89 Malignant neoplasm of overlapping sites of other parts of mouth
C09.0 Malignant neoplasm of tonsillar fossa
C09.1 Malignant neoplasm of tonsillar pillar (anterior) (posterior)
C09.8 Malignant neoplasm of overlapping sites of tonsil
C09.9* Malignant neoplasm of tonsil, unspecified
C10.0 Malignant neoplasm of vallecula
C10.1 Malignant neoplasm of anterior surface of epiglottis
C10.2 Malignant neoplasm of lateral wall of oropharynx
C10.3 Malignant neoplasm of posterior wall of oropharynx
C10.4 Malignant neoplasm of branchial cleft
C10.8 Malignant neoplasm of overlapping sites of oropharynx
C12 Malignant neoplasm of pyriform sinus
C13.0 Malignant neoplasm of postcricoid region
C13.1 Malignant neoplasm of aryepiglottic fold, hypopharyngeal aspect
C13.2 Malignant neoplasm of posterior wall of hypopharynx
C13.8 Malignant neoplasm of overlapping sites of hypopharynx
C14.2 Malignant neoplasm of Waldeyer's ring
C14.8 Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx
C15.3 Malignant neoplasm of upper third of esophagus
C15.4 Malignant neoplasm of middle third of esophagus
C15.5 Malignant neoplasm of lower third of esophagus
C15.8 Malignant neoplasm of overlapping sites of esophagus
C16.0 Malignant neoplasm of cardia
C16.1 Malignant neoplasm of fundus of stomach
C16.2 Malignant neoplasm of body of stomach
C16.3 Malignant neoplasm of pyloric antrum
C16.4 Malignant neoplasm of pylorus
C16.8 Malignant neoplasm of overlapping sites of stomach
C17.0 Malignant neoplasm of duodenum
C17.1 Malignant neoplasm of jejunum
C17.2 Malignant neoplasm of ileum
C17.3 Meckel's diverticulum, malignant
C17.8 Malignant neoplasm of overlapping sites of small intestine
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C22.1 Intrahepatic bile duct carcinoma
C23 Malignant neoplasm of gallbladder
C24.0 Malignant neoplasm of extrahepatic bile duct
C24.8 Malignant neoplasm of overlapping sites of biliary tract
C31.0 Malignant neoplasm of maxillary sinus
C31.1 Malignant neoplasm of ethmoidal sinus
C32.0 Malignant neoplasm of glottis
C32.1 Malignant neoplasm of supraglottis
C32.2 Malignant neoplasm of subglottis
C32.3 Malignant neoplasm of laryngeal cartilage
C32.8 Malignant neoplasm of overlapping sites of larynx
C40.01* Malignant neoplasm of scapula and long bones of right upper limb
C40.02* Malignant neoplasm of scapula and long bones of left upper limb
C40.11* Malignant neoplasm of short bones of right upper limb
C40.12* Malignant neoplasm of short bones of left upper limb
C40.21* Malignant neoplasm of long bones of right lower limb
C40.22* Malignant neoplasm of long bones of left lower limb
C40.31* Malignant neoplasm of short bones of right lower limb
C40.32* Malignant neoplasm of short bones of left lower limb
C40.81* Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb
C40.82* Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb
C41.0* Malignant neoplasm of bones of skull and face
C41.1* Malignant neoplasm of mandible
C41.2* Malignant neoplasm of vertebral column
C41.3* Malignant neoplasm of ribs, sternum and clavicle
C41.4* Malignant neoplasm of pelvic bones, sacrum and coccyx
C44.02 Squamous cell carcinoma of skin of lip
C44.09 Other specified malignant neoplasm of skin of lip
C48.1* Malignant neoplasm of specified parts of peritoneum
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C51.0 Malignant neoplasm of labium majus
C51.1 Malignant neoplasm of labium minus
C51.2 Malignant neoplasm of clitoris
C51.8 Malignant neoplasm of overlapping sites of vulva
C53.0 Malignant neoplasm of endocervix
C53.1 Malignant neoplasm of exocervix
C53.8 Malignant neoplasm of overlapping sites of cervix uteri
C54.0 Malignant neoplasm of isthmus uteri
C54.1 Malignant neoplasm of endometrium
C54.2 Malignant neoplasm of myometrium
C54.3 Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
C60.0 Malignant neoplasm of prepuce
C60.1 Malignant neoplasm of glans penis
C60.2 Malignant neoplasm of body of penis
C60.8 Malignant neoplasm of overlapping sites of penis
C61 Malignant neoplasm of prostate
C62.01 Malignant neoplasm of undescended right testis
C62.02 Malignant neoplasm of undescended left testis
C62.11 Malignant neoplasm of descended right testis
C62.12 Malignant neoplasm of descended left testis
C65.1 Malignant neoplasm of right renal pelvis
C65.2 Malignant neoplasm of left renal pelvis
C66.1 Malignant neoplasm of right ureter
C66.2 Malignant neoplasm of left ureter
C67.0 Malignant neoplasm of trigone of bladder
C67.1 Malignant neoplasm of dome of bladder
C67.2 Malignant neoplasm of lateral wall of bladder
C67.3 Malignant neoplasm of anterior wall of bladder
C67.4 Malignant neoplasm of posterior wall of bladder
C67.5 Malignant neoplasm of bladder neck
C67.6 Malignant neoplasm of ureteric orifice
C67.7 Malignant neoplasm of urachus
C67.8 Malignant neoplasm of overlapping sites of bladder
C68.0 Malignant neoplasm of urethra
C73 Malignant neoplasm of thyroid gland
C74.01 Malignant neoplasm of cortex of right adrenal gland
C74.02 Malignant neoplasm of cortex of left adrenal gland
C74.11 Malignant neoplasm of medulla of right adrenal gland
C74.12 Malignant neoplasm of medulla of left adrenal gland
C7A.1 Malignant poorly differentiated neuroendocrine tumors
C7A.8 Other malignant neuroendocrine tumors
C7B.8 Other secondary neuroendocrine tumors
Group 9 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code C09.9 for Malignant neoplasm of faucial tonsils or palatine tonsils.

*Note: Use ICD-10 codes C40.01, C40.02, C40.11, C40.12, C40.21, C40.22, C40.31, C40.32, C40.81, C40.82, C41.0, C41.1, C41.2, C41.3 or C41.4 for Bone Cancer Chondrosarcoma, Chordoma, Osteosarcoma, or Ewing Sarcoma.

*Note: Use ICD-10 code C48.1 for Primary Peritoneal Carcinoma.

Group 10

(66 Codes)
Group 10 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81261, 81262, and 81264.

Group 10 Codes
Code Description
C82.01 Follicular lymphoma grade I, lymph nodes of head, face, and neck
C82.02 Follicular lymphoma grade I, intrathoracic lymph nodes
C82.03 Follicular lymphoma grade I, intra-abdominal lymph nodes
C82.04 Follicular lymphoma grade I, lymph nodes of axilla and upper limb
C82.05 Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb
C82.06 Follicular lymphoma grade I, intrapelvic lymph nodes
C82.07 Follicular lymphoma grade I, spleen
C82.08 Follicular lymphoma grade I, lymph nodes of multiple sites
C82.09 Follicular lymphoma grade I, extranodal and solid organ sites
C82.11 Follicular lymphoma grade II, lymph nodes of head, face, and neck
C82.12 Follicular lymphoma grade II, intrathoracic lymph nodes
C82.13 Follicular lymphoma grade II, intra-abdominal lymph nodes
C82.14 Follicular lymphoma grade II, lymph nodes of axilla and upper limb
C82.15 Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb
C82.16 Follicular lymphoma grade II, intrapelvic lymph nodes
C82.17 Follicular lymphoma grade II, spleen
C82.18 Follicular lymphoma grade II, lymph nodes of multiple sites
C82.19 Follicular lymphoma grade II, extranodal and solid organ sites
C83.31* Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck
C83.32* Diffuse large B-cell lymphoma, intrathoracic lymph nodes
C83.33* Diffuse large B-cell lymphoma, intra-abdominal lymph nodes
C83.34* Diffuse large B-cell lymphoma, lymph nodes of axilla and upper limb
C83.35* Diffuse large B-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.36* Diffuse large B-cell lymphoma, intrapelvic lymph nodes
C83.37* Diffuse large B-cell lymphoma, spleen
C83.38* Diffuse large B-cell lymphoma, lymph nodes of multiple sites
C83.39* Diffuse large B-cell lymphoma, extranodal and solid organ sites
C83.51 Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck
C83.52 Lymphoblastic (diffuse) lymphoma, intrathoracic lymph nodes
C83.53 Lymphoblastic (diffuse) lymphoma, intra-abdominal lymph nodes
C83.54 Lymphoblastic (diffuse) lymphoma, lymph nodes of axilla and upper limb
C83.55 Lymphoblastic (diffuse) lymphoma, lymph nodes of inguinal region and lower limb
C83.56 Lymphoblastic (diffuse) lymphoma, intrapelvic lymph nodes
C83.57 Lymphoblastic (diffuse) lymphoma, spleen
C83.58 Lymphoblastic (diffuse) lymphoma, lymph nodes of multiple sites
C83.59 Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites
C83.71* Burkitt lymphoma, lymph nodes of head, face, and neck
C83.72* Burkitt lymphoma, intrathoracic lymph nodes
C83.73* Burkitt lymphoma, intra-abdominal lymph nodes
C83.74* Burkitt lymphoma, lymph nodes of axilla and upper limb
C83.75* Burkitt lymphoma, lymph nodes of inguinal region and lower limb
C83.76* Burkitt lymphoma, intrapelvic lymph nodes
C83.77* Burkitt lymphoma, spleen
C83.78* Burkitt lymphoma, lymph nodes of multiple sites
C83.79* Burkitt lymphoma, extranodal and solid organ sites
C83.81* Other non-follicular lymphoma, lymph nodes of head, face, and neck
C83.82* Other non-follicular lymphoma, intrathoracic lymph nodes
C83.83* Other non-follicular lymphoma, intra-abdominal lymph nodes
C83.84* Other non-follicular lymphoma, lymph nodes of axilla and upper limb
C83.85* Other non-follicular lymphoma, lymph nodes of inguinal region and lower limb
C83.86* Other non-follicular lymphoma, intrapelvic lymph nodes
C83.87* Other non-follicular lymphoma, spleen
C83.88* Other non-follicular lymphoma, lymph nodes of multiple sites
C83.89* Other non-follicular lymphoma, extranodal and solid organ sites
C85.81* Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck
C85.82* Other specified types of non-Hodgkin lymphoma, intrathoracic lymph nodes
C85.83* Other specified types of non-Hodgkin lymphoma, intra-abdominal lymph nodes
C85.84* Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb
C85.85* Other specified types of non-Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C85.86* Other specified types of non-Hodgkin lymphoma, intrapelvic lymph nodes
C85.87* Other specified types of non-Hodgkin lymphoma, spleen
C85.88* Other specified types of non-Hodgkin lymphoma, lymph nodes of multiple sites
C85.89* Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites
C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]
D47.Z1 Post-transplant lymphoproliferative disorder (PTLD)
D47.Z2 Castleman disease
Group 10 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C83.31-C83.39, C83.71-C83.79, C83.81-C83.89 or C85.81-C85.89 for AIDS-Related B-Cell Lymphomas.

*Note: Use ICD-10 codes C85.81-C85.86 or C85.88 for Nodal Marginal Zone Lymphoma.

*Note: Use ICD-10 code C85.87 for Splenic Marginal Zone Lymphoma.

Group 11

(31 Codes)
Group 11 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81263.

Group 11 Codes
Code Description
C83.01 Small cell B-cell lymphoma, lymph nodes of head, face, and neck
C83.02 Small cell B-cell lymphoma, intrathoracic lymph nodes
C83.03 Small cell B-cell lymphoma, intra-abdominal lymph nodes
C83.04 Small cell B-cell lymphoma, lymph nodes of axilla and upper limb
C83.05 Small cell B-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.06 Small cell B-cell lymphoma, intrapelvic lymph nodes
C83.07 Small cell B-cell lymphoma, spleen
C83.08 Small cell B-cell lymphoma, lymph nodes of multiple sites
C83.09 Small cell B-cell lymphoma, extranodal and solid organ sites
C83.11 Mantle cell lymphoma, lymph nodes of head, face, and neck
C83.12 Mantle cell lymphoma, intrathoracic lymph nodes
C83.13 Mantle cell lymphoma, intra-abdominal lymph nodes
C83.14 Mantle cell lymphoma, lymph nodes of axilla and upper limb
C83.15 Mantle cell lymphoma, lymph nodes of inguinal region and lower limb
C83.16 Mantle cell lymphoma, intrapelvic lymph nodes
C83.17 Mantle cell lymphoma, spleen
C83.18 Mantle cell lymphoma, lymph nodes of multiple sites
C83.19 Mantle cell lymphoma, extranodal and solid organ sites
C83.31* Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck
C83.32* Diffuse large B-cell lymphoma, intrathoracic lymph nodes
C83.33* Diffuse large B-cell lymphoma, intra-abdominal lymph nodes
C83.34* Diffuse large B-cell lymphoma, lymph nodes of axilla and upper limb
C83.35* Diffuse large B-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.36* Diffuse large B-cell lymphoma, intrapelvic lymph nodes
C83.37* Diffuse large B-cell lymphoma, spleen
C83.38* Diffuse large B-cell lymphoma, lymph nodes of multiple sites
C83.39* Diffuse large B-cell lymphoma, extranodal and solid organ sites
C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission
C91.12 Chronic lymphocytic leukemia of B-cell type in relapse
C91.40 Hairy cell leukemia not having achieved remission
C91.42 Hairy cell leukemia, in relapse
Group 11 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C83.31-C83.39 for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma - Histologic Transformation (Richter's) to Diffuse Large B-cell Lymphoma.

Group 12

(70 Codes)
Group 12 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81340, 81341, and 81342.

Group 12 Codes
Code Description
C84.01 Mycosis fungoides, lymph nodes of head, face, and neck
C84.02 Mycosis fungoides, intrathoracic lymph nodes
C84.03 Mycosis fungoides, intra-abdominal lymph nodes
C84.04 Mycosis fungoides, lymph nodes of axilla and upper limb
C84.05 Mycosis fungoides, lymph nodes of inguinal region and lower limb
C84.06 Mycosis fungoides, intrapelvic lymph nodes
C84.07 Mycosis fungoides, spleen
C84.08 Mycosis fungoides, lymph nodes of multiple sites
C84.09 Mycosis fungoides, extranodal and solid organ sites
C84.11 Sezary disease, lymph nodes of head, face, and neck
C84.12 Sezary disease, intrathoracic lymph nodes
C84.13 Sezary disease, intra-abdominal lymph nodes
C84.14 Sezary disease, lymph nodes of axilla and upper limb
C84.15 Sezary disease, lymph nodes of inguinal region and lower limb
C84.16 Sezary disease, intrapelvic lymph nodes
C84.17 Sezary disease, spleen
C84.18 Sezary disease, lymph nodes of multiple sites
C84.19 Sezary disease, extranodal and solid organ sites
C84.41* Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of head, face, and neck
C84.42* Peripheral T-cell lymphoma, not elsewhere classified, intrathoracic lymph nodes
C84.43* Peripheral T-cell lymphoma, not elsewhere classified, intra-abdominal lymph nodes
C84.44* Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of axilla and upper limb
C84.45* Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of inguinal region and lower limb
C84.46* Peripheral T-cell lymphoma, not elsewhere classified, intrapelvic lymph nodes
C84.47* Peripheral T-cell lymphoma, not elsewhere classified, spleen
C84.48* Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of multiple sites
C84.49* Peripheral T-cell lymphoma, not elsewhere classified, extranodal and solid organ sites
C84.61* Anaplastic large cell lymphoma, ALK-positive, lymph nodes of head, face, and neck
C84.62* Anaplastic large cell lymphoma, ALK-positive, intrathoracic lymph nodes
C84.63* Anaplastic large cell lymphoma, ALK-positive, intra-abdominal lymph nodes
C84.64* Anaplastic large cell lymphoma, ALK-positive, lymph nodes of axilla and upper limb
C84.65* Anaplastic large cell lymphoma, ALK-positive, lymph nodes of inguinal region and lower limb
C84.66* Anaplastic large cell lymphoma, ALK-positive, intrapelvic lymph nodes
C84.67* Anaplastic large cell lymphoma, ALK-positive, spleen
C84.68* Anaplastic large cell lymphoma, ALK-positive, lymph nodes of multiple sites
C84.69* Anaplastic large cell lymphoma, ALK-positive, extranodal and solid organ sites
C84.71* Anaplastic large cell lymphoma, ALK-negative, lymph nodes of head, face, and neck
C84.72* Anaplastic large cell lymphoma, ALK-negative, intrathoracic lymph nodes
C84.73* Anaplastic large cell lymphoma, ALK-negative, intra-abdominal lymph nodes
C84.74* Anaplastic large cell lymphoma, ALK-negative, lymph nodes of axilla and upper limb
C84.75* Anaplastic large cell lymphoma, ALK-negative, lymph nodes of inguinal region and lower limb
C84.76* Anaplastic large cell lymphoma, ALK-negative, intrapelvic lymph nodes
C84.77* Anaplastic large cell lymphoma, ALK-negative, spleen
C84.78* Anaplastic large cell lymphoma, ALK-negative, lymph nodes of multiple sites
C84.79* Anaplastic large cell lymphoma, ALK-negative, extranodal and solid organ sites
C84.7A* Anaplastic large cell lymphoma, ALK-negative, breast
C84.Z7* Other mature T/NK-cell lymphomas, spleen
C84.Z9* Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C86.0* Extranodal NK/T-cell lymphoma, nasal type
C86.1 Hepatosplenic T-cell lymphoma
C86.2* Enteropathy-type (intestinal) T-cell lymphoma
C86.5* Angioimmunoblastic T-cell lymphoma
C86.6 Primary cutaneous CD30-positive T-cell proliferations
C91.60 Prolymphocytic leukemia of T-cell type not having achieved remission
C91.62 Prolymphocytic leukemia of T-cell type, in relapse
C91.Z0* Other lymphoid leukemia not having achieved remission
C91.Z2* Other lymphoid leukemia, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
C94.80* Other specified leukemias not having achieved remission
C94.82* Other specified leukemias, in relapse
C96.Z* Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.Z2 Castleman disease
Group 12 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C84.41-C84.49, C84.61-C84.69, C84.71-C84.79, C84.7A, C86.2, or C86.5 for Peripheral T-Cell Lymphomas.

*Note: Use ICD-10 codes C84.Z7, C84.Z9 or C86.0 for Extranodal NK/T-Cell Lymphomas.

*Note: Use ICD-10 codes C91.Z0 or C91.Z2 for T-Cell Large Granular Lymphocytic Leukemia.

*Note: Use ICD-10 codes C94.80, C94.82 or C96.Z for Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Fusion Genes.

Group 13

(9 Codes)
Group 13 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81209, 81242, 81277, 81415, 81416, 81417, 81425, 81426, 81427, 0036U, and 0329U.

Group 13 Codes
Code Description
C94.6 Myelodysplastic disease, not elsewhere classified
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes

Group 14

(32 Codes)
Group 14 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81518, 81519, 81520, 81521, 81522, 81523, 0009U, 0155U, and 0177U.

Group 14 Codes
Code Description
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast

Group 15

(1 Code)
Group 15 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM code supports medical necessity and provides coverage for CPT codes: 81541, 81542, 0047U, and 0133U.

Group 15 Codes
Code Description
C61 Malignant neoplasm of prostate

Group 16

(1 Code)
Group 16 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM code supports medical necessity and provides coverage for CPT codes: 81313 and 81551.

 

Group 16 Codes
Code Description
N42.31* Prostatic intraepithelial neoplasia
Group 16 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code N42.31 for management of biopsy results - Atypia, suspicious for cancer; High-grade prostatic intraepithelial neoplasia (PIN).

Group 17

(1 Code)
Group 17 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM code supports medical necessity and provides coverage for CPT codes: 0005U, 0113U, and 0339U.

 

Group 17 Codes
Code Description
R97.20* Elevated prostate specific antigen [PSA]
Group 17 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code R97.20 post repeat PSA, digital rectal exam and workup for benign disease when:

PSA > 3 ng/mL and age 45 – 75 years old
PSA ≥ 4 ng/mL and age > 75 years old

Group 18

(4 Codes)
Group 18 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81552.

Group 18 Codes
Code Description
C69.31* Malignant neoplasm of right choroid
C69.32* Malignant neoplasm of left choroid
C69.41* Malignant neoplasm of right ciliary body
C69.42* Malignant neoplasm of left ciliary body
Group 18 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C69.31, C69.32, C69.41, or C69.42 for uveal melanoma.

Group 19

(14 Codes)
Group 19 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81525.

 

Group 19 Codes
Code Description
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal

Group 20

(64 Codes)
Group 20 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81120 and 81121.

Group 20 Codes
Code Description
C22.1 Intrahepatic bile duct carcinoma
C23 Malignant neoplasm of gallbladder
C24.0 Malignant neoplasm of extrahepatic bile duct
C24.8 Malignant neoplasm of overlapping sites of biliary tract
C40.01* Malignant neoplasm of scapula and long bones of right upper limb
C40.02* Malignant neoplasm of scapula and long bones of left upper limb
C40.11* Malignant neoplasm of short bones of right upper limb
C40.12* Malignant neoplasm of short bones of left upper limb
C40.21* Malignant neoplasm of long bones of right lower limb
C40.22* Malignant neoplasm of long bones of left lower limb
C40.31* Malignant neoplasm of short bones of right lower limb
C40.32* Malignant neoplasm of short bones of left lower limb
C40.81* Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb
C40.82* Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb
C41.0* Malignant neoplasm of bones of skull and face
C41.1* Malignant neoplasm of mandible
C41.2* Malignant neoplasm of vertebral column
C41.3* Malignant neoplasm of ribs, sternum and clavicle
C41.4* Malignant neoplasm of pelvic bones, sacrum and coccyx
C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles
C71.1 Malignant neoplasm of frontal lobe
C71.2 Malignant neoplasm of temporal lobe
C71.3 Malignant neoplasm of parietal lobe
C71.4 Malignant neoplasm of occipital lobe
C71.5 Malignant neoplasm of cerebral ventricle
C71.6 Malignant neoplasm of cerebellum
C71.7 Malignant neoplasm of brain stem
C71.8 Malignant neoplasm of overlapping sites of brain
C72.0 Malignant neoplasm of spinal cord
C86.4* Blastic NK-cell lymphoma
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis
Group 20 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C40.01, C40.02, C40.11, C40.12, C40.21, C40.22, C40.31, C40.32, C40.81, C40.82, C41.0, C41.1, C41.2, C41.3 or C41.4 for Chondrosarcoma.

*Note: Use ICD-10 code C86.4 for Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN).

Group 21

(8 Codes)
Group 21 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81170.

Group 21 Codes
Code Description
C91.00 Acute lymphoblastic leukemia not having achieved remission
C91.02 Acute lymphoblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse

Group 22

(39 Codes)
Group 22 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81175 and 81176.

Group 22 Codes
Code Description
C64.1* Malignant neoplasm of right kidney, except renal pelvis
C64.2* Malignant neoplasm of left kidney, except renal pelvis
C86.4* Blastic NK-cell lymphoma
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
C96.21 Aggressive systemic mastocytosis
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.02 Systemic mastocytosis
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis
Group 22 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C64.1 or C64.2 for Wilms Tumor.

*Note: Use ICD-10 code C86.4 for Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN).

Group 23

(29 Codes)
Group 23 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81201, 81203, and 0157U.

Group 23 Codes
Code Description
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C48.0* Malignant neoplasm of retroperitoneum
C48.1* Malignant neoplasm of specified parts of peritoneum
C48.8* Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C49.0* Malignant neoplasm of connective and soft tissue of head, face and neck
C49.11* Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder
C49.12* Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder
C49.21* Malignant neoplasm of connective and soft tissue of right lower limb, including hip
C49.22* Malignant neoplasm of connective and soft tissue of left lower limb, including hip
C49.3* Malignant neoplasm of connective and soft tissue of thorax
C49.4* Malignant neoplasm of connective and soft tissue of abdomen
C49.5* Malignant neoplasm of connective and soft tissue of pelvis
C49.8* Malignant neoplasm of overlapping sites of connective and soft tissue
C71.6 Malignant neoplasm of cerebellum
C71.7 Malignant neoplasm of brain stem
C71.8 Malignant neoplasm of overlapping sites of brain
Group 23 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C48.0, C48.1, C48.8, C49.0, C49.11, C49.12, C49.21, C49.22, C49.3, C49.4, C49.5, or C49.8 for soft tissue sarcoma desmoid fibromatosis.

Group 24

(66 Codes)
Group 24 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81210.

Group 24 Codes
Code Description
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C22.1 Intrahepatic bile duct carcinoma
C24.0 Malignant neoplasm of extrahepatic bile duct
C24.8 Malignant neoplasm of overlapping sites of biliary tract
C34.01 Malignant neoplasm of right main bronchus
C34.02 Malignant neoplasm of left main bronchus
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung
C43.0 Malignant melanoma of lip
C43.111 Malignant melanoma of right upper eyelid, including canthus
C43.112 Malignant melanoma of right lower eyelid, including canthus
C43.121 Malignant melanoma of left upper eyelid, including canthus
C43.122 Malignant melanoma of left lower eyelid, including canthus
C43.21 Malignant melanoma of right ear and external auricular canal
C43.22 Malignant melanoma of left ear and external auricular canal
C43.31 Malignant melanoma of nose
C43.39 Malignant melanoma of other parts of face
C43.4 Malignant melanoma of scalp and neck
C43.51 Malignant melanoma of anal skin
C43.52 Malignant melanoma of skin of breast
C43.59 Malignant melanoma of other part of trunk
C43.61 Malignant melanoma of right upper limb, including shoulder
C43.62 Malignant melanoma of left upper limb, including shoulder
C43.71 Malignant melanoma of right lower limb, including hip
C43.72 Malignant melanoma of left lower limb, including hip
C43.8 Malignant melanoma of overlapping sites of skin
C54.0 Malignant neoplasm of isthmus uteri
C54.1 Malignant neoplasm of endometrium
C54.2 Malignant neoplasm of myometrium
C54.3 Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles
C71.1 Malignant neoplasm of frontal lobe
C71.2 Malignant neoplasm of temporal lobe
C71.3 Malignant neoplasm of parietal lobe
C71.4 Malignant neoplasm of occipital lobe
C71.5 Malignant neoplasm of cerebral ventricle
C71.6 Malignant neoplasm of cerebellum
C71.7 Malignant neoplasm of brain stem
C71.8 Malignant neoplasm of overlapping sites of brain
C72.0 Malignant neoplasm of spinal cord
C73 Malignant neoplasm of thyroid gland
C91.40 Hairy cell leukemia not having achieved remission
C91.42 Hairy cell leukemia, in relapse
C96.0 Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis
C96.5 Multifocal and unisystemic Langerhans-cell histiocytosis
C96.6 Unifocal Langerhans-cell histiocytosis
D76.3* Other histiocytosis syndromes
Group 24 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code D76.3 for Erdheim-Chester Disease.

Group 25

(34 Codes)
Group 25 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81218.

Group 25 Codes
Code Description
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis

Group 26

(22 Codes)
Group 26 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81219, 81338, and 81339.

Group 26 Codes
Code Description
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis

Group 27

(11 Codes)
Group 27 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81233 and 81320.

Group 27 Codes
Code Description
C83.01 Small cell B-cell lymphoma, lymph nodes of head, face, and neck
C83.02 Small cell B-cell lymphoma, intrathoracic lymph nodes
C83.03 Small cell B-cell lymphoma, intra-abdominal lymph nodes
C83.04 Small cell B-cell lymphoma, lymph nodes of axilla and upper limb
C83.05 Small cell B-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.06 Small cell B-cell lymphoma, intrapelvic lymph nodes
C83.07 Small cell B-cell lymphoma, spleen
C83.08 Small cell B-cell lymphoma, lymph nodes of multiple sites
C83.09 Small cell B-cell lymphoma, extranodal and solid organ sites
C91.10 Chronic lymphocytic leukemia of B-cell type not having achieved remission
C91.12 Chronic lymphocytic leukemia of B-cell type in relapse

Group 28

(9 Codes)
Group 28 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81235, 0179U, 0388U, and 0397U.

Group 28 Codes
Code Description
C34.01 Malignant neoplasm of right main bronchus
C34.02 Malignant neoplasm of left main bronchus
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung

Group 29

(40 Codes)
Group 29 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81236 and 81237.

Group 29 Codes
Code Description
C82.01 Follicular lymphoma grade I, lymph nodes of head, face, and neck
C82.02 Follicular lymphoma grade I, intrathoracic lymph nodes
C82.03 Follicular lymphoma grade I, intra-abdominal lymph nodes
C82.04 Follicular lymphoma grade I, lymph nodes of axilla and upper limb
C82.05 Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb
C82.06 Follicular lymphoma grade I, intrapelvic lymph nodes
C82.07 Follicular lymphoma grade I, spleen
C82.08 Follicular lymphoma grade I, lymph nodes of multiple sites
C82.09 Follicular lymphoma grade I, extranodal and solid organ sites
C82.11 Follicular lymphoma grade II, lymph nodes of head, face, and neck
C82.12 Follicular lymphoma grade II, intrathoracic lymph nodes
C82.13 Follicular lymphoma grade II, intra-abdominal lymph nodes
C82.14 Follicular lymphoma grade II, lymph nodes of axilla and upper limb
C82.15 Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb
C82.16 Follicular lymphoma grade II, intrapelvic lymph nodes
C82.17 Follicular lymphoma grade II, spleen
C82.18 Follicular lymphoma grade II, lymph nodes of multiple sites
C82.19 Follicular lymphoma grade II, extranodal and solid organ sites
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis

Group 30

(39 Codes)
Group 30 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81245, 81246, and 0046U.

Group 30 Codes
Code Description
C91.00 Acute lymphoblastic leukemia not having achieved remission
C91.02 Acute lymphoblastic leukemia, in relapse
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
C94.80* Other specified leukemias not having achieved remission
C94.82* Other specified leukemias, in relapse
C96.Z* Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis
Group 30 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C94.80, C94.82 or C96.Z for Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Fusion Genes.

Group 31

(12 Codes)
Group 31 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 0023U and 0050U.

Group 31 Codes
Code Description
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse

Group 32

(16 Codes)
Group 32 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81270, 81279, 0017U, and 0027U.

Group 32 Codes
Code Description
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis

Group 33

(54 Codes)
Group 33 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81272.

Group 33 Codes
Code Description
C43.0 Malignant melanoma of lip
C43.111 Malignant melanoma of right upper eyelid, including canthus
C43.112 Malignant melanoma of right lower eyelid, including canthus
C43.121 Malignant melanoma of left upper eyelid, including canthus
C43.122 Malignant melanoma of left lower eyelid, including canthus
C43.21 Malignant melanoma of right ear and external auricular canal
C43.22 Malignant melanoma of left ear and external auricular canal
C43.31 Malignant melanoma of nose
C43.39 Malignant melanoma of other parts of face
C43.4 Malignant melanoma of scalp and neck
C43.51 Malignant melanoma of anal skin
C43.52 Malignant melanoma of skin of breast
C43.59 Malignant melanoma of other part of trunk
C43.61 Malignant melanoma of right upper limb, including shoulder
C43.62 Malignant melanoma of left upper limb, including shoulder
C43.71 Malignant melanoma of right lower limb, including hip
C43.72 Malignant melanoma of left lower limb, including hip
C43.8 Malignant melanoma of overlapping sites of skin
C49.A1 Gastrointestinal stromal tumor of esophagus
C49.A2 Gastrointestinal stromal tumor of stomach
C49.A3 Gastrointestinal stromal tumor of small intestine
C49.A4 Gastrointestinal stromal tumor of large intestine
C49.A5 Gastrointestinal stromal tumor of rectum
C49.A9 Gastrointestinal stromal tumor of other sites
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.80* Other specified leukemias not having achieved remission
C94.82* Other specified leukemias, in relapse
C96.21 Aggressive systemic mastocytosis
C96.Z* Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
D45 Polycythemia vera
D47.02 Systemic mastocytosis
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis
Group 33 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C94.80, C94.82 or C96.Z for Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Fusion Genes.

Group 34

(11 Codes)
Group 34 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81273.

Group 34 Codes
Code Description
C49.A1 Gastrointestinal stromal tumor of esophagus
C49.A2 Gastrointestinal stromal tumor of stomach
C49.A3 Gastrointestinal stromal tumor of small intestine
C49.A4 Gastrointestinal stromal tumor of large intestine
C49.A5 Gastrointestinal stromal tumor of rectum
C49.A9 Gastrointestinal stromal tumor of other sites
C94.80* Other specified leukemias not having achieved remission
C94.82* Other specified leukemias, in relapse
C96.21 Aggressive systemic mastocytosis
C96.Z* Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
D47.02 Systemic mastocytosis
Group 34 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C94.80, C94.82 or C96.Z for Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Fusion Genes.

Group 35

(71 Codes)
Group 35 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81275 and 81276.

Group 35 Codes
Code Description
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C24.1 Malignant neoplasm of ampulla of Vater
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C34.01 Malignant neoplasm of right main bronchus
C34.02 Malignant neoplasm of left main bronchus
C34.11 Malignant neoplasm of upper lobe, right bronchus or lung
C34.12 Malignant neoplasm of upper lobe, left bronchus or lung
C34.2 Malignant neoplasm of middle lobe, bronchus or lung
C34.31 Malignant neoplasm of lower lobe, right bronchus or lung
C34.32 Malignant neoplasm of lower lobe, left bronchus or lung
C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung
C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung
C48.0* Malignant neoplasm of retroperitoneum
C48.1* Malignant neoplasm of specified parts of peritoneum
C48.8* Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C49.0* Malignant neoplasm of connective and soft tissue of head, face and neck
C49.11* Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder
C49.12* Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder
C49.21* Malignant neoplasm of connective and soft tissue of right lower limb, including hip
C49.22* Malignant neoplasm of connective and soft tissue of left lower limb, including hip
C49.3* Malignant neoplasm of connective and soft tissue of thorax
C49.4* Malignant neoplasm of connective and soft tissue of abdomen
C49.5* Malignant neoplasm of connective and soft tissue of pelvis
C49.8* Malignant neoplasm of overlapping sites of connective and soft tissue
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C93.30 Juvenile myelomonocytic leukemia, not having achieved remission
C93.32 Juvenile myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
C96.0 Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis
C96.5 Multifocal and unisystemic Langerhans-cell histiocytosis
C96.6 Unifocal Langerhans-cell histiocytosis
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis
D76.3* Other histiocytosis syndromes
Group 35 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C48.0, C48.1, C48.8, C49.0, C49.11, C49.12, C49.21, C49.22, C49.3, C49.4, C49.5, or C49.8 for soft tissue sarcoma embryonal rhabdomyosarcoma.

*Note: Use ICD-10 code D76.3 for Erdheim-Chester Disease or Rosai-Dorfman Disease.

Group 36

(10 Codes)
Group 36 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81287.

Group 36 Codes
Code Description
C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles
C71.1 Malignant neoplasm of frontal lobe
C71.2 Malignant neoplasm of temporal lobe
C71.3 Malignant neoplasm of parietal lobe
C71.4 Malignant neoplasm of occipital lobe
C71.5 Malignant neoplasm of cerebral ventricle
C71.6 Malignant neoplasm of cerebellum
C71.7 Malignant neoplasm of brain stem
C71.8 Malignant neoplasm of overlapping sites of brain
C72.0 Malignant neoplasm of spinal cord

Group 37

(77 Codes)
Group 37 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81292, 81294, 81295, 81297, 81298, 81300, 81317, 81319, 0158U, 0159U, 0160U, and 0161U.

Group 37 Codes
Code Description
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C24.1 Malignant neoplasm of ampulla of Vater
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C45.0* Mesothelioma of pleura
C45.1* Mesothelioma of peritoneum
C48.1* Malignant neoplasm of specified parts of peritoneum
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C54.0 Malignant neoplasm of isthmus uteri
C54.1 Malignant neoplasm of endometrium
C54.2 Malignant neoplasm of myometrium
C54.3 Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
C61 Malignant neoplasm of prostate
C94.6 Myelodysplastic disease, not elsewhere classified
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
Group 37 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: ICD-10 codes C45.0 and C45.1 may only be reported with CPT codes 81298, 81300, and 0160U.

*Note: Use ICD-10 code C48.1 for Primary Peritoneal Carcinoma.

Group 38

(65 Codes)
Group 38 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81293, 81296, 81299, and 81318.

Group 38 Codes
Code Description
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C48.1* Malignant neoplasm of specified parts of peritoneum
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C54.0 Malignant neoplasm of isthmus uteri
C54.1 Malignant neoplasm of endometrium
C54.2 Malignant neoplasm of myometrium
C54.3 Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
C61 Malignant neoplasm of prostate
Group 38 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code C48.1 for Primary Peritoneal Carcinoma.

Group 39

(12 Codes)
Group 39 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81305.

Group 39 Codes
Code Description
C85.81* Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck
C85.82* Other specified types of non-Hodgkin lymphoma, intrathoracic lymph nodes
C85.83* Other specified types of non-Hodgkin lymphoma, intra-abdominal lymph nodes
C85.84* Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb
C85.85* Other specified types of non-Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C85.86* Other specified types of non-Hodgkin lymphoma, intrapelvic lymph nodes
C85.87* Other specified types of non-Hodgkin lymphoma, spleen
C85.88* Other specified types of non-Hodgkin lymphoma, lymph nodes of multiple sites
C88.0 Waldenstrom macroglobulinemia
C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]
C90.00 Multiple myeloma not having achieved remission
C90.02 Multiple myeloma in relapse
Group 39 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C85.81-C85.86 or C85.88 for Nodal Marginal Zone Lymphoma.

*Note: Use ICD-10 code C85.87 for Splenic Marginal Zone Lymphoma.

Group 40

(58 Codes)
Group 40 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81307 and 0137U.

Group 40 Codes
Code Description
C24.1 Malignant neoplasm of ampulla of Vater
C25.0 Malignant neoplasm of head of pancreas
C25.1 Malignant neoplasm of body of pancreas
C25.2 Malignant neoplasm of tail of pancreas
C25.3 Malignant neoplasm of pancreatic duct
C25.4 Malignant neoplasm of endocrine pancreas
C25.7 Malignant neoplasm of other parts of pancreas
C25.8 Malignant neoplasm of overlapping sites of pancreas
C48.1* Malignant neoplasm of specified parts of peritoneum
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
C61 Malignant neoplasm of prostate
C64.1* Malignant neoplasm of right kidney, except renal pelvis
C64.2* Malignant neoplasm of left kidney, except renal pelvis
C94.6 Myelodysplastic disease, not elsewhere classified
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
Group 40 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code C48.1 for Primary Peritoneal Carcinoma.

*Note: Use ICD-10 codes C64.1 or C64.2 for Wilms Tumor.

Group 41

(56 Codes)
Group 41 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81309.

Group 41 Codes
Code Description
C07 Malignant neoplasm of parotid gland
C08.0 Malignant neoplasm of submandibular gland
C08.1 Malignant neoplasm of sublingual gland
C48.0* Malignant neoplasm of retroperitoneum
C48.1* Malignant neoplasm of specified parts of peritoneum
C48.8* Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C49.0* Malignant neoplasm of connective and soft tissue of head, face and neck
C49.11* Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder
C49.12* Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder
C49.21* Malignant neoplasm of connective and soft tissue of right lower limb, including hip
C49.22* Malignant neoplasm of connective and soft tissue of left lower limb, including hip
C49.3* Malignant neoplasm of connective and soft tissue of thorax
C49.4* Malignant neoplasm of connective and soft tissue of abdomen
C49.5* Malignant neoplasm of connective and soft tissue of pelvis
C49.8* Malignant neoplasm of overlapping sites of connective and soft tissue
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C54.0 Malignant neoplasm of isthmus uteri
C54.1 Malignant neoplasm of endometrium
C54.2 Malignant neoplasm of myometrium
C54.3 Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C96.0 Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis
C96.5 Multifocal and unisystemic Langerhans-cell histiocytosis
C96.6 Unifocal Langerhans-cell histiocytosis
D76.3* Other histiocytosis syndromes
Group 41 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C48.0, C48.1, C48.8, C49.0, C49.11, C49.12, C49.21, C49.22, C49.3, C49.4, C49.5, or C49.8 for soft tissue sarcoma embryonal rhabdomyosarcoma.

*Note: Use ICD-10 code D76.3 for Erdheim-Chester Disease or Rosai-Dorfman Disease.

Group 42

(37 Codes)
Group 42 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81310 and 0049U.

Group 42 Codes
Code Description
C86.4* Blastic NK-cell lymphoma
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.30 Myeloid sarcoma, not having achieved remission
C92.32 Myeloid sarcoma, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis
Group 42 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code C86.4 for Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN).

Group 43

(48 Codes)
Group 43 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81311.

Group 43 Codes
Code Description
C18.0 Malignant neoplasm of cecum
C18.1 Malignant neoplasm of appendix
C18.2 Malignant neoplasm of ascending colon
C18.3 Malignant neoplasm of hepatic flexure
C18.4 Malignant neoplasm of transverse colon
C18.5 Malignant neoplasm of splenic flexure
C18.6 Malignant neoplasm of descending colon
C18.7 Malignant neoplasm of sigmoid colon
C18.8 Malignant neoplasm of overlapping sites of colon
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.1 Malignant neoplasm of anal canal
C21.2 Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C48.0* Malignant neoplasm of retroperitoneum
C48.1* Malignant neoplasm of specified parts of peritoneum
C48.8* Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum
C49.0* Malignant neoplasm of connective and soft tissue of head, face and neck
C49.11* Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder
C49.12* Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder
C49.21* Malignant neoplasm of connective and soft tissue of right lower limb, including hip
C49.22* Malignant neoplasm of connective and soft tissue of left lower limb, including hip
C49.3* Malignant neoplasm of connective and soft tissue of thorax
C49.4* Malignant neoplasm of connective and soft tissue of abdomen
C49.5* Malignant neoplasm of connective and soft tissue of pelvis
C49.8* Malignant neoplasm of overlapping sites of connective and soft tissue
C86.4* Blastic NK-cell lymphoma
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C93.30 Juvenile myelomonocytic leukemia, not having achieved remission
C93.32 Juvenile myelomonocytic leukemia, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
C96.0 Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis
C96.5 Multifocal and unisystemic Langerhans-cell histiocytosis
C96.6 Unifocal Langerhans-cell histiocytosis
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D76.3* Other histiocytosis syndromes
Group 43 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C48.0, C48.1, C48.8, C49.0, C49.11, C49.12, C49.21, C49.22, C49.3, C49.4, C49.5, or C49.8 for soft tissue sarcoma embryonal rhabdomyosarcoma.

*Note: Use ICD-10 code C86.4 for Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN).

*Note: Use ICD-10 code D76.3 for Erdheim-Chester Disease or Rosai-Dorfman Disease.

Group 44

(9 Codes)
Group 44 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81314.

Group 44 Codes
Code Description
C49.A1 Gastrointestinal stromal tumor of esophagus
C49.A2 Gastrointestinal stromal tumor of stomach
C49.A3 Gastrointestinal stromal tumor of small intestine
C49.A4 Gastrointestinal stromal tumor of large intestine
C49.A5 Gastrointestinal stromal tumor of rectum
C49.A9 Gastrointestinal stromal tumor of other sites
C94.80* Other specified leukemias not having achieved remission
C94.82* Other specified leukemias, in relapse
C96.Z* Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
Group 44 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C94.80, C94.82 or C96.Z for Myeloid/Lymphoid Neoplasms with Eosinophilia and Tyrosine Kinase Fusion Genes.

Group 45

(39 Codes)
Group 45 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 81321, 81322, 81323, and 0235U.

Group 45 Codes
Code Description
C48.1* Malignant neoplasm of specified parts of peritoneum
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.3 Malignant neoplasm of bilateral ovaries
C57.01 Malignant neoplasm of right fallopian tube
C57.02 Malignant neoplasm of left fallopian tube
Q85.81 PTEN tumor syndrome
Group 45 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 code C48.1 for Primary Peritoneal Carcinoma.

Group 46

(36 Codes)
Group 46 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81334.

Group 46 Codes
Code Description
C92.00 Acute myeloblastic leukemia, not having achieved remission
C92.02 Acute myeloblastic leukemia, in relapse
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.40 Acute promyelocytic leukemia, not having achieved remission
C92.42 Acute promyelocytic leukemia, in relapse
C92.50 Acute myelomonocytic leukemia, not having achieved remission
C92.52 Acute myelomonocytic leukemia, in relapse
C92.60 Acute myeloid leukemia with 11q23-abnormality not having achieved remission
C92.62 Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C93.00 Acute monoblastic/monocytic leukemia, not having achieved remission
C93.02 Acute monoblastic/monocytic leukemia, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
C96.21 Aggressive systemic mastocytosis
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.02 Systemic mastocytosis
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis

Group 47

(24 Codes)
Group 47 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81345.

Group 47 Codes
Code Description
C54.0 Malignant neoplasm of isthmus uteri
C54.1 Malignant neoplasm of endometrium
C54.2 Malignant neoplasm of myometrium
C54.3 Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles
C71.1 Malignant neoplasm of frontal lobe
C71.2 Malignant neoplasm of temporal lobe
C71.3 Malignant neoplasm of parietal lobe
C71.4 Malignant neoplasm of occipital lobe
C71.5 Malignant neoplasm of cerebral ventricle
C71.6 Malignant neoplasm of cerebellum
C71.7 Malignant neoplasm of brain stem
C71.8 Malignant neoplasm of overlapping sites of brain
C72.0 Malignant neoplasm of spinal cord
C94.6 Myelodysplastic disease, not elsewhere classified
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes

Group 48

(26 Codes)
Group 48 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81347.

Group 48 Codes
Code Description
C69.31* Malignant neoplasm of right choroid
C69.32* Malignant neoplasm of left choroid
C69.41* Malignant neoplasm of right ciliary body
C69.42* Malignant neoplasm of left ciliary body
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B Refractory cytopenia with multilineage dysplasia and ring sideroblasts
D46.C Myelodysplastic syndrome with isolated del(5q) chromosomal abnormality
D46.Z Other myelodysplastic syndromes
D47.1 Chronic myeloproliferative disease
D47.3 Essential (hemorrhagic) thrombocythemia
D47.4 Osteomyelofibrosis
D75.81 Myelofibrosis
Group 48 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Note: Use ICD-10 codes C69.31, C69.32, C69.41, or C69.42 for uveal melanoma.

Group 49

(24 Codes)
Group 49 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT code: 81348.

Group 49 Codes
Code Description
C92.10 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
C92.12 Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission
C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C93.10 Chronic myelomonocytic leukemia not having achieved remission
C93.12 Chronic myelomonocytic leukemia, in relapse
C94.40 Acute panmyelosis with myelofibrosis not having achieved remission
C94.42 Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
C96.21 Aggressive systemic mastocytosis
D45 Polycythemia vera
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.21 Refractory anemia with excess of blasts 1
D46.22 Refractory anemia with excess of blasts 2
D46.A Refractory cytopenia with multilineage dysplasia
D46.B