SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Erythropoiesis Stimulating Agents (ESA)

A56462

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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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General Information

Source Article ID
N/A
Article ID
A56462
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Erythropoiesis Stimulating Agents (ESA)
Article Type
Billing and Coding
Original Effective Date
10/03/2019
Revision Effective Date
10/01/2023
Revision Ending Date
11/15/2023
Retirement Date
N/A
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 8, “Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims” for specific billing instructions for ESAs.

CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30

Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L34356-Erythropoiesis Stimulating Agents (ESA).

 

General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

Effective January 1, 2008, all non-ESRD claims billing HCPCS Q5106, J0881 and J0885 must begin reporting one of the following modifiers:

  • EA: ESA, anemia, chemo-induced;
  • EB: ESA, anemia, radio-induced;
  • EC: ESA, anemia, non-chemo/radio.

Effective January 1, 2008, the following claims must report the most recent hematocrit or hemoglobin reading:
All claims billing for the administration of an ESA (HCPCS J0881, J0882, J0885, J0886, Q4081, Q5105, and Q5106). 

For institutional claims the hemoglobin reading is reported with a value code 48 and a hematocrit reading is reported with the value code 49. Claims not reporting a value code 48 or 49 will be returned to the provider.

For professional paper claims, test results are reported in item 19 of the Form CMS-1500 claim form. For electronic claims (837P), providers report the hemoglobin or hematocrit readings in Loop 2400 MEA segment. The specifics are mEA01=TR (for test results), MEA02=R1 (for hemoglobin) orR2 (for hematocrit), and MEA03= the test results.


For dates of service on or after January 1, 2007, all providers are encouraged to include route of administration modifiers, JA for intravenous administration and JB for subcutaneous administration, on claims billing Q4081, Q5105, J0882 for ESRD beneficiaries. (CMS Publication 100-04, Medicare Claims Processing Manual, Transmittal No. 1212, Change Request #5480, March 30, 2007, 2005, Requirement for providing route of administration codes for Erythropoiesis stimulating agents.)

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

 

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

 

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

 

Effective February 23, 2013, Omontys ® (HCPCS code J0890) has been recalled by the FDA and will no longer be covered by CGS. The effective date of this non-coverage is February 23, 2013. More information regarding this recall is available on the FDA website.

Other Comments:

Bill type codes for Home Health services are not listed in the LCD for Erythropoiesis Stimulating Agents (ESAs) because " drugs and biologicals are specifically excluded from coverage by the statute section 1861(m)(5) of the Act.”

The administration of an ESA may be a qualifying service for Home Health services. The beneficiary must be receiving the ESA for a covered indication, as specified in this LCD.

For claims submitted to the Part A MAC: This coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS Administrators, LLC to process their claims.

Bill type codes only apply to providers who bill these services to the Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

For dates of service prior to April 1, 2010, FQHC services should be reported with bill type 73x. For dates of service on or after April 1, 2010, bill type 77x should be used to report FQHC services.

Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
071x Clinic - Rural Health
072x Clinic - Hospital Based or Independent Renal Dialysis Center
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
0634 Pharmacy - Erythropoietin (EPO)<10,000 units
0635 Pharmacy - Erythropoietin (EPO)>=10,000 Units
0636 Pharmacy - Drugs Requiring Detailed Coding
N/A

CPT/HCPCS Codes

Group 1

(7 Codes)
Group 1 Paragraph

Note: Effective February 23, 2013, Omontys ® (J0890) has been recalled by the FDA and will no longer be covered by CGS. More information regarding this recall is available on the FDA website.

Group 1 Codes
Code Description
J0881 INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)
J0882 INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS)
J0885 INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
J0890 INJECTION, PEGINESATIDE, 0.1 MG (FOR ESRD ON DIALYSIS)
Q4081 INJECTION, EPOETIN ALFA, 100 UNITS (FOR ESRD ON DIALYSIS)
Q5105 INJECTION, EPOETIN ALFA-EPBX, BIOSIMILAR, (RETACRIT) (FOR ESRD ON DIALYSIS), 100 UNITS
Q5106 INJECTION, EPOETIN ALFA-EPBX, BIOSIMILAR, (RETACRIT) (FOR NON-ESRD USE), 1000 UNITS
N/A

CPT/HCPCS Modifiers

Group 1

(5 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
EA ERYTHROPOETIC STIMULATING AGENT (ESA) ADMINISTERED TO TREAT ANEMIA DUE TO ANTI-CANCER CHEMOTHERAPY
EB ERYTHROPOETIC STIMULATING AGENT (ESA) ADMINISTERED TO TREAT ANEMIA DUE TO ANTI-CANCER RADIOTHERAPY
EC ERYTHROPOETIC STIMULATING AGENT (ESA) ADMINISTERED TO TREAT ANEMIA NOT DUE TO ANTI-CANCER RADIOTHERAPY OR ANTI-CANCER CHEMOTHERAPY
ED HEMATOCRIT LEVEL HAS EXCEEDED 39% (OR HEMOGLOBIN LEVEL HAS EXCEEDED 13.0 G/DL) FOR 3 OR MORE CONSECUTIVE BILLING CYCLES IMMEDIATELY PRIOR TO AND INCLUDING THE CURRENT CYCLE
EE HEMATOCRIT LEVEL HAS NOT EXCEEDED 39% (OR HEMOGLOBIN LEVEL HAS NOT EXCEEDED 13.0 G/DL) FOR 3 OR MORE CONSECUTIVE BILLING CYCLES IMMEDIATELY PRIOR TO AND INCLUDING THE CURRENT CYCLE
N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(2 Codes)
Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

For Patients on Dialysis (Both diagnoses must be on claim.)

Group 1 Codes
Code Description
D63.1 Anemia in chronic kidney disease
N18.6 End stage renal disease

Group 2

(11 Codes)
Group 2 Paragraph

For patients with chronic kidney disease (not yet on dialysis) and anemia – must include D63.1 and one other listed diagnosis.

 

Note: Patients with stage I and II do not meet the creatinine clearance or GFR requirements in coverage criteria B for the following codes:

I12.9*
I13.0*

Group 2 Codes
Code Description
I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
N18.30 Chronic kidney disease, stage 3 unspecified
N18.31 Chronic kidney disease, stage 3a
N18.32 Chronic kidney disease, stage 3b
N18.4 Chronic kidney disease, stage 4 (severe)
N18.5 Chronic kidney disease, stage 5

Group 3

(3 Codes)
Group 3 Paragraph

Patients with anemia related to treatment with zidovudine and/or other Nucleoside Reverse Transcriptase Inhibitors (NRTI) for HIV disease. Must have one of the following D61.1 and either B20 or B97.35 on the claim.

Group 3 Codes
Code Description
B20 Human immunodeficiency virus [HIV] disease
B97.35 Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere
D61.1 Drug-induced aplastic anemia

Group 4

(1,018 Codes)
Group 4 Paragraph

For patients with anemia related to chemotherapy, claims must be reported with ICD-10-CM code D64.81 (antineoplastic chemotherapy induced anemia) representing the anemia related to chemotherapy plus the non-myeloid malignancy for which the chemotherapy was administered. Note: C92.00-C92.91, C92.Z0-C92.Z2, C93.00-C93.91, C94.00-C94.02, C94.20-C94.82, C95.00-C95.91, or D45 are myeloid malignancies and are excluded from coverage.)

Group 4 Codes
Code Description
C00.0 - C00.6 Malignant neoplasm of external upper lip - Malignant neoplasm of commissure of lip, unspecified
C00.8 Malignant neoplasm of overlapping sites of lip
C00.9 Malignant neoplasm of lip, unspecified
C01 Malignant neoplasm of base of tongue
C02.0 - C02.4 Malignant neoplasm of dorsal surface of tongue - Malignant neoplasm of lingual tonsil
C02.8 Malignant neoplasm of overlapping sites of tongue
C02.9 Malignant neoplasm of tongue, unspecified
C03.0 Malignant neoplasm of upper gum
C03.1 Malignant neoplasm of lower gum
C03.9 Malignant neoplasm of gum, unspecified
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
C04.9 Malignant neoplasm of floor of mouth, unspecified
C05.0 - C05.2 Malignant neoplasm of hard palate - Malignant neoplasm of uvula
C05.8 Malignant neoplasm of overlapping sites of palate
C06.0 - C06.2 Malignant neoplasm of cheek mucosa - Malignant neoplasm of retromolar area
C06.89 Malignant neoplasm of overlapping sites of other parts of mouth
C06.9 Malignant neoplasm of mouth, unspecified
C07 Malignant neoplasm of parotid gland
C08.0 Malignant neoplasm of submandibular gland
C08.1 Malignant neoplasm of sublingual gland
C08.9 Malignant neoplasm of major salivary gland, unspecified
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
C10.0 - C10.4 Malignant neoplasm of vallecula - Malignant neoplasm of branchial cleft
C10.8 Malignant neoplasm of overlapping sites of oropharynx
C10.9 Malignant neoplasm of oropharynx, unspecified
C11.0 - C11.3 Malignant neoplasm of superior wall of nasopharynx - Malignant neoplasm of anterior wall of nasopharynx
C11.8 Malignant neoplasm of overlapping sites of nasopharynx
C11.9 Malignant neoplasm of nasopharynx, unspecified
C12 Malignant neoplasm of pyriform sinus
C13.0 - C13.2 Malignant neoplasm of postcricoid region - Malignant neoplasm of posterior wall of hypopharynx
C13.8 Malignant neoplasm of overlapping sites of hypopharynx
C13.9 Malignant neoplasm of hypopharynx, unspecified
C14.0 Malignant neoplasm of pharynx, unspecified
C14.2 Malignant neoplasm of Waldeyer's ring
C14.8 Malignant neoplasm of overlapping sites of lip, oral cavity and pharynx
C15.3 - C15.5 Malignant neoplasm of upper third of esophagus - Malignant neoplasm of lower third of esophagus
C15.8 Malignant neoplasm of overlapping sites of esophagus
C15.9 Malignant neoplasm of esophagus, unspecified
C16.0 - C16.6 Malignant neoplasm of cardia - Malignant neoplasm of greater curvature of stomach, unspecified
C16.8 Malignant neoplasm of overlapping sites of stomach
C16.9 Malignant neoplasm of stomach, unspecified
C17.0 - C17.3 Malignant neoplasm of duodenum - Meckel's diverticulum, malignant
C17.8 Malignant neoplasm of overlapping sites of small intestine
C17.9 Malignant neoplasm of small intestine, unspecified
C18.0 - C18.9 Malignant neoplasm of cecum - Malignant neoplasm of colon, unspecified
C19 Malignant neoplasm of rectosigmoid junction
C20 Malignant neoplasm of rectum
C21.0 - C21.2 Malignant neoplasm of anus, unspecified - Malignant neoplasm of cloacogenic zone
C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal
C22.0 - C22.4 Liver cell carcinoma - Other sarcomas of liver
C22.7 - C22.9 Other specified carcinomas of liver - Malignant neoplasm of liver, not specified as primary or secondary
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
C24.9 Malignant neoplasm of biliary tract, unspecified
C25.0 - C25.4 Malignant neoplasm of head of pancreas - Malignant neoplasm of endocrine pancreas
C25.7 - C25.9 Malignant neoplasm of other parts of pancreas - Malignant neoplasm of pancreas, unspecified
C26.0 Malignant neoplasm of intestinal tract, part unspecified
C26.1 Malignant neoplasm of spleen
C26.9 Malignant neoplasm of ill-defined sites within the digestive system
C30.0 Malignant neoplasm of nasal cavity
C30.1 Malignant neoplasm of middle ear
C31.0 - C31.3 Malignant neoplasm of maxillary sinus - Malignant neoplasm of sphenoid sinus
C31.8 Malignant neoplasm of overlapping sites of accessory sinuses
C31.9 Malignant neoplasm of accessory sinus, unspecified
C32.0 - C32.3 Malignant neoplasm of glottis - Malignant neoplasm of laryngeal cartilage
C32.8 Malignant neoplasm of overlapping sites of larynx
C32.9 Malignant neoplasm of larynx, unspecified
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 - C38.4 Malignant neoplasm of heart - Malignant neoplasm of pleura
C38.8 Malignant neoplasm of overlapping sites of heart, mediastinum and pleura
C39.0 Malignant neoplasm of upper respiratory tract, part unspecified
C39.9 Malignant neoplasm of lower respiratory tract, part unspecified
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 - C41.4 Malignant neoplasm of bones of skull and face - 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
C43.30 Malignant melanoma of unspecified part of face
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
C43.9 Malignant melanoma of skin, unspecified
C44.00 - C44.02 Unspecified malignant neoplasm of skin of lip - Squamous cell carcinoma of skin of lip
C44.09 Other specified malignant neoplasm of skin of lip
C44.1021 Unspecified malignant neoplasm of skin of right upper eyelid, including canthus
C44.1022 Unspecified malignant neoplasm of skin of right lower eyelid, including canthus
C44.1091 Unspecified malignant neoplasm of skin of left upper eyelid, including canthus
C44.1092 Unspecified malignant neoplasm of skin of left lower eyelid, including canthus
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
C44.1921 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
C44.202 Unspecified malignant neoplasm of skin of right ear and external auricular canal
C44.209 Unspecified malignant neoplasm of skin of left ear and external auricular canal
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
C44.300 Unspecified malignant neoplasm of skin of unspecified part of face
C44.301 Unspecified malignant neoplasm of skin of nose
C44.309 Unspecified malignant neoplasm of skin of other parts of face
C44.310 Basal cell carcinoma of skin of unspecified parts of face
C44.311 Basal cell carcinoma of skin of nose
C44.319 Basal cell carcinoma of skin of other parts of face
C44.320 Squamous cell carcinoma of skin of unspecified parts of face
C44.321 Squamous cell carcinoma of skin of nose
C44.329 Squamous cell carcinoma of skin of other parts of face
C44.390 Other specified malignant neoplasm of skin of unspecified 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
C44.40 - C44.42 Unspecified malignant neoplasm of skin of scalp and neck - Squamous cell carcinoma of skin of scalp and neck
C44.49 Other specified malignant neoplasm of skin of scalp and neck
C44.500 Unspecified malignant neoplasm of anal skin
C44.501 Unspecified malignant neoplasm of skin of breast
C44.509 Unspecified malignant neoplasm of skin of other part of trunk
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
C44.602 Unspecified malignant neoplasm of skin of right upper limb, including shoulder
C44.609 Unspecified malignant neoplasm of skin of left upper limb, including shoulder
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
C44.702 Unspecified malignant neoplasm of skin of right lower limb, including hip
C44.709 Unspecified malignant neoplasm of skin of left lower limb, including hip
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
C44.80 - C44.82 Unspecified malignant neoplasm of overlapping sites of skin - Squamous cell carcinoma of overlapping sites of skin
C44.89 Other specified malignant neoplasm of overlapping sites of skin
C44.90 - C44.92 Unspecified malignant neoplasm of skin, unspecified - Squamous cell carcinoma of skin, unspecified
C44.99 Other specified malignant neoplasm of skin, unspecified
C45.0 - C45.2 Mesothelioma of pleura - Mesothelioma of pericardium
C45.7 Mesothelioma of other sites
C45.9 Mesothelioma, unspecified
C46.0 - C46.4 Kaposi's sarcoma of skin - 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
C46.9 Kaposi's sarcoma, unspecified
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 - C47.6 Malignant neoplasm of peripheral nerves of thorax - Malignant neoplasm of peripheral nerves of trunk, unspecified
C47.8 Malignant neoplasm of overlapping sites of peripheral nerves and autonomic nervous system
C47.9 Malignant neoplasm of peripheral nerves and autonomic nervous system, unspecified
C48.0 - C48.2 Malignant neoplasm of retroperitoneum - Malignant neoplasm of peritoneum, unspecified
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 - C49.6 Malignant neoplasm of connective and soft tissue of thorax - Malignant neoplasm of connective and soft tissue of trunk, unspecified
C49.8 Malignant neoplasm of overlapping sites of connective and soft tissue
C49.9 Malignant neoplasm of connective and soft tissue, unspecified
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
C50.911 Malignant neoplasm of unspecified site of right female breast
C50.912 Malignant neoplasm of unspecified site of left female breast
C50.921 Malignant neoplasm of unspecified site of right male breast
C50.922 Malignant neoplasm of unspecified site of left male breast
C51.0 - C51.2 Malignant neoplasm of labium majus - Malignant neoplasm of clitoris
C51.8 Malignant neoplasm of overlapping sites of vulva
C51.9 Malignant neoplasm of vulva, unspecified
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
C53.9 Malignant neoplasm of cervix uteri, unspecified
C54.0 - C54.3 Malignant neoplasm of isthmus uteri - Malignant neoplasm of fundus uteri
C54.8 Malignant neoplasm of overlapping sites of corpus uteri
C55 Malignant neoplasm of uterus, part unspecified
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
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
C57.4 Malignant neoplasm of uterine adnexa, unspecified
C57.7 Malignant neoplasm of other specified female genital organs
C58 Malignant neoplasm of placenta
C60.0 - C60.2 Malignant neoplasm of prepuce - Malignant neoplasm of body of penis
C60.8 Malignant neoplasm of overlapping sites of penis
C60.9 Malignant neoplasm of penis, unspecified
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
C62.91 Malignant neoplasm of right testis, unspecified whether descended or undescended
C62.92 Malignant neoplasm of left testis, unspecified whether descended or undescended
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 - C63.9 Malignant neoplasm of other specified male genital organs - Malignant neoplasm of male genital organ, unspecified
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 - C67.9 Malignant neoplasm of trigone of bladder - Malignant neoplasm of bladder, unspecified
C68.0 Malignant neoplasm of urethra
C68.1 Malignant neoplasm of paraurethral glands
C68.8 Malignant neoplasm of overlapping sites of urinary organs
C68.9 Malignant neoplasm of urinary organ, unspecified
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
C69.91 Malignant neoplasm of unspecified site of right eye
C69.92 Malignant neoplasm of unspecified site of left eye
C70.0 Malignant neoplasm of cerebral meninges
C70.1 Malignant neoplasm of spinal meninges
C71.0 - C71.9 Malignant neoplasm of cerebrum, except lobes and ventricles - Malignant neoplasm of brain, unspecified
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
C72.9 Malignant neoplasm of central nervous system, unspecified
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
C74.91 Malignant neoplasm of unspecified part of right adrenal gland
C74.92 Malignant neoplasm of unspecified part of left adrenal gland
C75.0 - C75.5 Malignant neoplasm of parathyroid gland - Malignant neoplasm of aortic body and other paraganglia
C75.8 Malignant neoplasm with pluriglandular involvement, unspecified
C75.9 Malignant neoplasm of endocrine gland, unspecified
C76.0 - C76.3 Malignant neoplasm of head, face and neck - Malignant neoplasm of pelvis
C76.41 Malignant neoplasm of right upper limb
C76.42 Malignant neoplasm of left upper limb
C76.51 Malignant neoplasm of right lower limb
C76.52 Malignant neoplasm of left lower limb
C76.8 Malignant neoplasm of other specified ill-defined sites
C77.0 - C77.5 Secondary and unspecified malignant neoplasm of lymph nodes of head, face and neck - Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes
C77.8 Secondary and unspecified malignant neoplasm of lymph nodes of multiple regions
C77.9 Secondary and unspecified malignant neoplasm of lymph node, unspecified
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 - C78.7 Secondary malignant neoplasm of small intestine - 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
C80.0 Disseminated malignant neoplasm, unspecified
C80.1 Malignant (primary) neoplasm, unspecified
C81.01 - C81.09 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck - Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites
C81.11 - C81.19 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck - Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites
C81.21 - C81.29 Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck - Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites
C81.31 - C81.39 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck - Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites
C81.41 - C81.49 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck - Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites
C81.71 - C81.79 Other Hodgkin lymphoma, lymph nodes of head, face, and neck - Other Hodgkin lymphoma, extranodal and solid organ sites
C81.91 - C81.99 Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck - Hodgkin lymphoma, unspecified, extranodal and solid organ sites
C82.01 - C82.09 Follicular lymphoma grade I, lymph nodes of head, face, and neck - Follicular lymphoma grade I, extranodal and solid organ sites
C82.11 - C82.19 Follicular lymphoma grade II, lymph nodes of head, face, and neck - Follicular lymphoma grade II, extranodal and solid organ sites
C82.21 - C82.29 Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck - Follicular lymphoma grade III, unspecified, extranodal and solid organ sites
C82.31 - C82.39 Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck - Follicular lymphoma grade IIIa, extranodal and solid organ sites
C82.41 - C82.49 Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck - Follicular lymphoma grade IIIb, extranodal and solid organ sites
C82.51 - C82.59 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck - Diffuse follicle center lymphoma, extranodal and solid organ sites
C82.61 - C82.69 Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck - Cutaneous follicle center lymphoma, extranodal and solid organ sites
C82.81 - C82.89 Other types of follicular lymphoma, lymph nodes of head, face, and neck - Other types of follicular lymphoma, extranodal and solid organ sites
C82.91 - C82.99 Follicular lymphoma, unspecified, lymph nodes of head, face, and neck - Follicular lymphoma, unspecified, extranodal and solid organ sites
C83.01 - C83.09 Small cell B-cell lymphoma, lymph nodes of head, face, and neck - Small cell B-cell lymphoma, extranodal and solid organ sites
C83.11 - C83.19 Mantle cell lymphoma, lymph nodes of head, face, and neck - Mantle cell lymphoma, extranodal and solid organ sites
C83.31 - C83.39 Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck - Diffuse large B-cell lymphoma, extranodal and solid organ sites
C83.51 - C83.59 Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck - Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites
C83.71 - C83.79 Burkitt lymphoma, lymph nodes of head, face, and neck - Burkitt lymphoma, extranodal and solid organ sites
C83.81 - C83.89 Other non-follicular lymphoma, lymph nodes of head, face, and neck - Other non-follicular lymphoma, extranodal and solid organ sites
C83.91 - C83.99 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck - Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites
C84.01 - C84.09 Mycosis fungoides, lymph nodes of head, face, and neck - Mycosis fungoides, extranodal and solid organ sites
C84.11 - C84.19 Sezary disease, lymph nodes of head, face, and neck - Sezary disease, extranodal and solid organ sites
C84.41 - C84.49 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of head, face, and neck - Peripheral T-cell lymphoma, not elsewhere classified, extranodal and solid organ sites
C84.61 - C84.69 Anaplastic large cell lymphoma, ALK-positive, lymph nodes of head, face, and neck - Anaplastic large cell lymphoma, ALK-positive, extranodal and solid organ sites
C84.71 - C84.79 Anaplastic large cell lymphoma, ALK-negative, lymph nodes of head, face, and neck - 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
C84.91 - C84.99 Mature T/NK-cell lymphomas, unspecified, lymph nodes of head, face, and neck - Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
C85.11 - C85.19 Unspecified B-cell lymphoma, lymph nodes of head, face, and neck - Unspecified B-cell lymphoma, extranodal and solid organ sites
C85.21 - C85.29 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck - Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites
C85.81 - C85.89 Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck - Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites
C85.91 - C85.98 Non-Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck - Non-Hodgkin lymphoma, unspecified, lymph nodes of multiple sites
C85.99 Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites
C86.0 - C86.6 Extranodal NK/T-cell lymphoma, nasal type - Primary cutaneous CD30-positive T-cell proliferations
C88.2 - C88.4 Heavy chain disease - Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]
C88.8 Other malignant immunoproliferative diseases
C90.00 - C90.02 Multiple myeloma not having achieved remission - Multiple myeloma in relapse
C90.10 - C90.12 Plasma cell leukemia not having achieved remission - Plasma cell leukemia in relapse
C90.20 - C90.22 Extramedullary plasmacytoma not having achieved remission - Extramedullary plasmacytoma in relapse
C90.30 - C90.32 Solitary plasmacytoma not having achieved remission - Solitary plasmacytoma in relapse
C91.00 - C91.02 Acute lymphoblastic leukemia not having achieved remission - Acute lymphoblastic leukemia, in relapse
C91.10 - C91.12 Chronic lymphocytic leukemia of B-cell type not having achieved remission - Chronic lymphocytic leukemia of B-cell type in relapse
C91.30 - C91.32 Prolymphocytic leukemia of B-cell type not having achieved remission - Prolymphocytic leukemia of B-cell type, in relapse
C91.40 - C91.42 Hairy cell leukemia not having achieved remission - Hairy cell leukemia, in relapse
C91.50 - C91.52 Adult T-cell lymphoma/leukemia (HTLV-1-associated) not having achieved remission - Adult T-cell lymphoma/leukemia (HTLV-1-associated), in relapse
C91.60 - C91.62 Prolymphocytic leukemia of T-cell type not having achieved remission - Prolymphocytic leukemia of T-cell type, in relapse
C91.A0 Mature B-cell leukemia Burkitt-type not having achieved remission
C91.A1 Mature B-cell leukemia Burkitt-type, in remission
C91.A2 Mature B-cell leukemia Burkitt-type, in relapse
C91.Z0 Other lymphoid leukemia not having achieved remission
C91.Z1 Other lymphoid leukemia, in remission
C91.Z2 Other lymphoid leukemia, in relapse
C91.90 - C91.92 Lymphoid leukemia, unspecified not having achieved remission - Lymphoid leukemia, unspecified, in relapse
C94.40 - C94.42 Acute panmyelosis with myelofibrosis not having achieved remission - Acute panmyelosis with myelofibrosis, in relapse
C94.6 Myelodysplastic disease, not elsewhere classified
C96.0 Multifocal and multisystemic (disseminated) Langerhans-cell histiocytosis
C96.20 Malignant mast cell neoplasm, unspecified
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.A Histiocytic sarcoma
C96.Z Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
C96.9 Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified
D03.0 Melanoma in situ of lip
D03.111 Melanoma in situ of right upper eyelid, including canthus
D03.112 Melanoma in situ of right lower eyelid, including canthus
D03.121 Melanoma in situ of left upper eyelid, including canthus
D03.122 Melanoma in situ of left lower eyelid, including canthus
D03.21 Melanoma in situ of right ear and external auricular canal
D03.22 Melanoma in situ of left ear and external auricular canal
D03.30 Melanoma in situ of unspecified part of face
D03.39 Melanoma in situ of other parts of face
D03.4 Melanoma in situ of scalp and neck
D03.51 Melanoma in situ of anal skin
D03.52 Melanoma in situ of breast (skin) (soft tissue)
D03.59 Melanoma in situ of other part of trunk
D03.61 Melanoma in situ of right upper limb, including shoulder
D03.62 Melanoma in situ of left upper limb, including shoulder
D03.71 Melanoma in situ of right lower limb, including hip
D03.72 Melanoma in situ of left lower limb, including hip
D03.8 Melanoma in situ of other sites
D03.9 Melanoma in situ, unspecified
D07.1 Carcinoma in situ of vulva
D07.2 Carcinoma in situ of vagina
D07.30 Carcinoma in situ of unspecified female genital organs
D07.39 Carcinoma in situ of other female genital organs
D37.01 Neoplasm of uncertain behavior of lip
D37.02 Neoplasm of uncertain behavior of tongue
D37.030 - D37.032 Neoplasm of uncertain behavior of the parotid salivary glands - Neoplasm of uncertain behavior of the submandibular salivary glands
D37.04 Neoplasm of uncertain behavior of the minor salivary glands
D37.05 Neoplasm of uncertain behavior of pharynx
D37.09 Neoplasm of uncertain behavior of other specified sites of the oral cavity
D37.1 - D37.6 Neoplasm of uncertain behavior of stomach - Neoplasm of uncertain behavior of liver, gallbladder and bile ducts
D37.8 Neoplasm of uncertain behavior of other specified digestive organs
D38.0 - D38.5 Neoplasm of uncertain behavior of larynx - Neoplasm of uncertain behavior of other respiratory organs
D39.0 Neoplasm of uncertain behavior of uterus
D39.11 Neoplasm of uncertain behavior of right ovary
D39.12 Neoplasm of uncertain behavior of left ovary
D39.2 Neoplasm of uncertain behavior of placenta
D39.8 Neoplasm of uncertain behavior of other specified female genital organs
D40.0 Neoplasm of uncertain behavior of prostate
D40.11 Neoplasm of uncertain behavior of right testis
D40.12 Neoplasm of uncertain behavior of left testis
D40.8 Neoplasm of uncertain behavior of other specified male genital organs
D41.01 Neoplasm of uncertain behavior of right kidney
D41.02 Neoplasm of uncertain behavior of left kidney
D41.11 Neoplasm of uncertain behavior of right renal pelvis
D41.12 Neoplasm of uncertain behavior of left renal pelvis
D41.21 Neoplasm of uncertain behavior of right ureter
D41.22 Neoplasm of uncertain behavior of left ureter
D41.3 Neoplasm of uncertain behavior of urethra
D41.4 Neoplasm of uncertain behavior of bladder
D41.8 Neoplasm of uncertain behavior of other specified urinary organs
D41.9 Neoplasm of uncertain behavior of unspecified urinary organ
D42.0 Neoplasm of uncertain behavior of cerebral meninges
D42.1 Neoplasm of uncertain behavior of spinal meninges
D43.0 Neoplasm of uncertain behavior of brain, supratentorial
D43.1 Neoplasm of uncertain behavior of brain, infratentorial
D43.3 Neoplasm of uncertain behavior of cranial nerves
D43.4 Neoplasm of uncertain behavior of spinal cord
D43.8 Neoplasm of uncertain behavior of other specified parts of central nervous system
D44.0 Neoplasm of uncertain behavior of thyroid gland
D44.11 Neoplasm of uncertain behavior of right adrenal gland
D44.12 Neoplasm of uncertain behavior of left adrenal gland
D44.2 - D44.7 Neoplasm of uncertain behavior of parathyroid gland - Neoplasm of uncertain behavior of aortic body and other paraganglia
D47.01 Cutaneous mastocytosis
D47.02 Systemic mastocytosis
D47.09 Other mast cell neoplasms of uncertain behavior
D47.1 Chronic myeloproliferative disease
D47.Z9 Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue
D48.0 - D48.5 Neoplasm of uncertain behavior of bone and articular cartilage - Neoplasm of uncertain behavior of skin
D48.61 Neoplasm of uncertain behavior of right breast
D48.62 Neoplasm of uncertain behavior of left breast
D48.7 Neoplasm of uncertain behavior of other specified sites
D48.9 Neoplasm of uncertain behavior, unspecified
D49.0 - D49.4 Neoplasm of unspecified behavior of digestive system - Neoplasm of unspecified behavior of bladder
D49.511 Neoplasm of unspecified behavior of right kidney
D49.512 Neoplasm of unspecified behavior of left kidney
D49.59 Neoplasm of unspecified behavior of other genitourinary organ
D49.6 Neoplasm of unspecified behavior of brain
D49.7 Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system
D49.81 Neoplasm of unspecified behavior of retina and choroid
D49.89 Neoplasm of unspecified behavior of other specified sites
D49.9 Neoplasm of unspecified behavior of unspecified site
Q85.00 - Q85.02 Neurofibromatosis, unspecified - Neurofibromatosis, type 2
Q85.09 Other neurofibromatosis
Z51.11 Encounter for antineoplastic chemotherapy
Z51.12 Encounter for antineoplastic immunotherapy

Group 5

(8 Codes)
Group 5 Paragraph

Patients with anemia related to Myelodysplastic Syndrome.

Group 5 Codes
Code Description
D46.0 Refractory anemia without ring sideroblasts, so stated
D46.1 Refractory anemia with ring sideroblasts
D46.20 Refractory anemia with excess of blasts, unspecified
D46.21 Refractory anemia with excess of blasts 1
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
D46.4 Refractory anemia, unspecified

Group 6

(3 Codes)
Group 6 Paragraph

Preoperative use in specified patients. Must have an anemia diagnosis (Note: D63.8 or D64.9) and other specified prophylactic measure diagnosis. (Anemia must be primary diagnosis).

ICD-10-CM code Z41.8 is to be used only when the patient meets all coverage criteria for patients who are preoperative for hip or knee surgery for the following code:

Z41.8

Group 6 Codes
Code Description
D63.8 Anemia in other chronic diseases classified elsewhere
D64.9 Anemia, unspecified
Z41.8 Encounter for other procedures for purposes other than remedying health state

Group 7

(207 Codes)
Group 7 Paragraph

For patients with anemia of chronic disease, claims must include D63.8(anemia of other chronic disease) and one other listed diagnosis.

Group 7 Codes
Code Description
B17.10 Acute hepatitis C without hepatic coma
B17.11 Acute hepatitis C with hepatic coma
B18.2 Chronic viral hepatitis C
B19.20 Unspecified viral hepatitis C without hepatic coma
B19.21 Unspecified viral hepatitis C with hepatic coma
K50.00 Crohn's disease of small intestine without complications
K50.011 - K50.014 Crohn's disease of small intestine with rectal bleeding - Crohn's disease of small intestine with abscess
K50.018 Crohn's disease of small intestine with other complication
K50.10 Crohn's disease of large intestine without complications
K50.111 - K50.114 Crohn's disease of large intestine with rectal bleeding - Crohn's disease of large intestine with abscess
K50.118 Crohn's disease of large intestine with other complication
K50.80 Crohn's disease of both small and large intestine without complications
K50.811 - K50.814 Crohn's disease of both small and large intestine with rectal bleeding - Crohn's disease of both small and large intestine with abscess
K50.818 Crohn's disease of both small and large intestine with other complication
K50.90 Crohn's disease, unspecified, without complications
K50.911 - K50.914 Crohn's disease, unspecified, with rectal bleeding - Crohn's disease, unspecified, with abscess
K50.918 Crohn's disease, unspecified, with other complication
K51.00 Ulcerative (chronic) pancolitis without complications
K51.011 - K51.014 Ulcerative (chronic) pancolitis with rectal bleeding - Ulcerative (chronic) pancolitis with abscess
K51.018 Ulcerative (chronic) pancolitis with other complication
K51.20 Ulcerative (chronic) proctitis without complications
K51.211 - K51.214 Ulcerative (chronic) proctitis with rectal bleeding - Ulcerative (chronic) proctitis with abscess
K51.218 Ulcerative (chronic) proctitis with other complication
K51.30 Ulcerative (chronic) rectosigmoiditis without complications
K51.311 - K51.314 Ulcerative (chronic) rectosigmoiditis with rectal bleeding - Ulcerative (chronic) rectosigmoiditis with abscess
K51.318 Ulcerative (chronic) rectosigmoiditis with other complication
K51.40 Inflammatory polyps of colon without complications
K51.411 - K51.414 Inflammatory polyps of colon with rectal bleeding - Inflammatory polyps of colon with abscess
K51.418 Inflammatory polyps of colon with other complication
K51.50 Left sided colitis without complications
K51.511 - K51.514 Left sided colitis with rectal bleeding - Left sided colitis with abscess
K51.518 Left sided colitis with other complication
K51.80 Other ulcerative colitis without complications
K51.811 - K51.814 Other ulcerative colitis with rectal bleeding - Other ulcerative colitis with abscess
K51.818 Other ulcerative colitis with other complication
K51.90 Ulcerative colitis, unspecified, without complications
K51.911 - K51.914 Ulcerative colitis, unspecified with rectal bleeding - Ulcerative colitis, unspecified with abscess
K51.918 Ulcerative colitis, unspecified with other complication
M05.411 Rheumatoid myopathy with rheumatoid arthritis of right shoulder
M05.412 Rheumatoid myopathy with rheumatoid arthritis of left shoulder
M05.421 Rheumatoid myopathy with rheumatoid arthritis of right elbow
M05.422 Rheumatoid myopathy with rheumatoid arthritis of left elbow
M05.431 Rheumatoid myopathy with rheumatoid arthritis of right wrist
M05.432 Rheumatoid myopathy with rheumatoid arthritis of left wrist
M05.441 Rheumatoid myopathy with rheumatoid arthritis of right hand
M05.442 Rheumatoid myopathy with rheumatoid arthritis of left hand
M05.451 Rheumatoid myopathy with rheumatoid arthritis of right hip
M05.452 Rheumatoid myopathy with rheumatoid arthritis of left hip
M05.461 Rheumatoid myopathy with rheumatoid arthritis of right knee
M05.462 Rheumatoid myopathy with rheumatoid arthritis of left knee
M05.471 Rheumatoid myopathy with rheumatoid arthritis of right ankle and foot
M05.472 Rheumatoid myopathy with rheumatoid arthritis of left ankle and foot
M05.49 Rheumatoid myopathy with rheumatoid arthritis of multiple sites
M05.511 Rheumatoid polyneuropathy with rheumatoid arthritis of right shoulder
M05.512 Rheumatoid polyneuropathy with rheumatoid arthritis of left shoulder
M05.521 Rheumatoid polyneuropathy with rheumatoid arthritis of right elbow
M05.522 Rheumatoid polyneuropathy with rheumatoid arthritis of left elbow
M05.531 Rheumatoid polyneuropathy with rheumatoid arthritis of right wrist
M05.532 Rheumatoid polyneuropathy with rheumatoid arthritis of left wrist
M05.541 Rheumatoid polyneuropathy with rheumatoid arthritis of right hand
M05.542 Rheumatoid polyneuropathy with rheumatoid arthritis of left hand
M05.551 Rheumatoid polyneuropathy with rheumatoid arthritis of right hip
M05.552 Rheumatoid polyneuropathy with rheumatoid arthritis of left hip
M05.561 Rheumatoid polyneuropathy with rheumatoid arthritis of right knee
M05.562 Rheumatoid polyneuropathy with rheumatoid arthritis of left knee
M05.571 Rheumatoid polyneuropathy with rheumatoid arthritis of right ankle and foot
M05.572 Rheumatoid polyneuropathy with rheumatoid arthritis of left ankle and foot
M05.59 Rheumatoid polyneuropathy with rheumatoid arthritis of multiple sites
M05.711 Rheumatoid arthritis with rheumatoid factor of right shoulder without organ or systems involvement
M05.712 Rheumatoid arthritis with rheumatoid factor of left shoulder without organ or systems involvement
M05.721 Rheumatoid arthritis with rheumatoid factor of right elbow without organ or systems involvement
M05.722 Rheumatoid arthritis with rheumatoid factor of left elbow without organ or systems involvement
M05.731 Rheumatoid arthritis with rheumatoid factor of right wrist without organ or systems involvement
M05.732 Rheumatoid arthritis with rheumatoid factor of left wrist without organ or systems involvement
M05.741 Rheumatoid arthritis with rheumatoid factor of right hand without organ or systems involvement
M05.742 Rheumatoid arthritis with rheumatoid factor of left hand without organ or systems involvement
M05.751 Rheumatoid arthritis with rheumatoid factor of right hip without organ or systems involvement
M05.752 Rheumatoid arthritis with rheumatoid factor of left hip without organ or systems involvement
M05.761 Rheumatoid arthritis with rheumatoid factor of right knee without organ or systems involvement
M05.762 Rheumatoid arthritis with rheumatoid factor of left knee without organ or systems involvement
M05.771 Rheumatoid arthritis with rheumatoid factor of right ankle and foot without organ or systems involvement
M05.772 Rheumatoid arthritis with rheumatoid factor of left ankle and foot without organ or systems involvement
M05.79 Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
M05.7A Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvement
M05.811 Other rheumatoid arthritis with rheumatoid factor of right shoulder
M05.812 Other rheumatoid arthritis with rheumatoid factor of left shoulder
M05.821 Other rheumatoid arthritis with rheumatoid factor of right elbow
M05.822 Other rheumatoid arthritis with rheumatoid factor of left elbow
M05.831 Other rheumatoid arthritis with rheumatoid factor of right wrist
M05.832 Other rheumatoid arthritis with rheumatoid factor of left wrist
M05.841 Other rheumatoid arthritis with rheumatoid factor of right hand
M05.842 Other rheumatoid arthritis with rheumatoid factor of left hand
M05.851 Other rheumatoid arthritis with rheumatoid factor of right hip
M05.852 Other rheumatoid arthritis with rheumatoid factor of left hip
M05.861 Other rheumatoid arthritis with rheumatoid factor of right knee
M05.862 Other rheumatoid arthritis with rheumatoid factor of left knee
M05.871 Other rheumatoid arthritis with rheumatoid factor of right ankle and foot
M05.872 Other rheumatoid arthritis with rheumatoid factor of left ankle and foot
M05.89 Other rheumatoid arthritis with rheumatoid factor of multiple sites
M06.011 Rheumatoid arthritis without rheumatoid factor, right shoulder
M06.012 Rheumatoid arthritis without rheumatoid factor, left shoulder
M06.021 Rheumatoid arthritis without rheumatoid factor, right elbow
M06.022 Rheumatoid arthritis without rheumatoid factor, left elbow
M06.031 Rheumatoid arthritis without rheumatoid factor, right wrist
M06.032 Rheumatoid arthritis without rheumatoid factor, left wrist
M06.041 Rheumatoid arthritis without rheumatoid factor, right hand
M06.042 Rheumatoid arthritis without rheumatoid factor, left hand
M06.051 Rheumatoid arthritis without rheumatoid factor, right hip
M06.052 Rheumatoid arthritis without rheumatoid factor, left hip
M06.061 Rheumatoid arthritis without rheumatoid factor, right knee
M06.062 Rheumatoid arthritis without rheumatoid factor, left knee
M06.071 Rheumatoid arthritis without rheumatoid factor, right ankle and foot
M06.072 Rheumatoid arthritis without rheumatoid factor, left ankle and foot
M06.08 Rheumatoid arthritis without rheumatoid factor, vertebrae
M06.09 Rheumatoid arthritis without rheumatoid factor, multiple sites
M06.211 Rheumatoid bursitis, right shoulder
M06.212 Rheumatoid bursitis, left shoulder
M06.221 Rheumatoid bursitis, right elbow
M06.222 Rheumatoid bursitis, left elbow
M06.231 Rheumatoid bursitis, right wrist
M06.232 Rheumatoid bursitis, left wrist
M06.241 Rheumatoid bursitis, right hand
M06.242 Rheumatoid bursitis, left hand
M06.251 Rheumatoid bursitis, right hip
M06.252 Rheumatoid bursitis, left hip
M06.261 Rheumatoid bursitis, right knee
M06.262 Rheumatoid bursitis, left knee
M06.271 Rheumatoid bursitis, right ankle and foot
M06.272 Rheumatoid bursitis, left ankle and foot
M06.28 Rheumatoid bursitis, vertebrae
M06.29 Rheumatoid bursitis, multiple sites
M06.311 Rheumatoid nodule, right shoulder
M06.312 Rheumatoid nodule, left shoulder
M06.321 Rheumatoid nodule, right elbow
M06.322 Rheumatoid nodule, left elbow
M06.331 Rheumatoid nodule, right wrist
M06.332 Rheumatoid nodule, left wrist
M06.341 Rheumatoid nodule, right hand
M06.342 Rheumatoid nodule, left hand
M06.351 Rheumatoid nodule, right hip
M06.352 Rheumatoid nodule, left hip
M06.361 Rheumatoid nodule, right knee
M06.362 Rheumatoid nodule, left knee
M06.371 Rheumatoid nodule, right ankle and foot
M06.372 Rheumatoid nodule, left ankle and foot
M06.38 Rheumatoid nodule, vertebrae
M06.39 Rheumatoid nodule, multiple sites
M06.811 Other specified rheumatoid arthritis, right shoulder
M06.812 Other specified rheumatoid arthritis, left shoulder
M06.821 Other specified rheumatoid arthritis, right elbow
M06.822 Other specified rheumatoid arthritis, left elbow
M06.831 Other specified rheumatoid arthritis, right wrist
M06.832 Other specified rheumatoid arthritis, left wrist
M06.841 Other specified rheumatoid arthritis, right hand
M06.842 Other specified rheumatoid arthritis, left hand
M06.851 Other specified rheumatoid arthritis, right hip
M06.852 Other specified rheumatoid arthritis, left hip
M06.861 Other specified rheumatoid arthritis, right knee
M06.862 Other specified rheumatoid arthritis, left knee
M06.871 Other specified rheumatoid arthritis, right ankle and foot
M06.872 Other specified rheumatoid arthritis, left ankle and foot
M06.88 Other specified rheumatoid arthritis, vertebrae
M06.89 Other specified rheumatoid arthritis, multiple sites
M32.0 Drug-induced systemic lupus erythematosus
M32.10 - M32.15 Systemic lupus erythematosus, organ or system involvement unspecified - Tubulo-interstitial nephropathy in systemic lupus erythematosus
M32.19 Other organ or system involvement in systemic lupus erythematosus
M32.8 Other forms of systemic lupus erythematosus
T37.5X5A Adverse effect of antiviral drugs, initial encounter
T37.5X5S Adverse effect of antiviral drugs, sequela
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(66 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
C92.00 - C92.02 Acute myeloblastic leukemia, not having achieved remission - Acute myeloblastic leukemia, in relapse
C92.10 - C92.12 Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission - Chronic myeloid leukemia, BCR/ABL-positive, in relapse
C92.20 - C92.22 Atypical chronic myeloid leukemia, BCR/ABL-negative, not having achieved remission - Atypical chronic myeloid leukemia, BCR/ABL-negative, in relapse
C92.30 - C92.32 Myeloid sarcoma, not having achieved remission - Myeloid sarcoma, in relapse
C92.40 - C92.42 Acute promyelocytic leukemia, not having achieved remission - Acute promyelocytic leukemia, in relapse
C92.50 - C92.52 Acute myelomonocytic leukemia, not having achieved remission - Acute myelomonocytic leukemia, in relapse
C92.60 - C92.62 Acute myeloid leukemia with 11q23-abnormality not having achieved remission - Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 Acute myeloid leukemia with multilineage dysplasia, not having achieved remission
C92.A1 Acute myeloid leukemia with multilineage dysplasia, in remission
C92.A2 Acute myeloid leukemia with multilineage dysplasia, in relapse
C92.Z0 Other myeloid leukemia not having achieved remission
C92.Z1 Other myeloid leukemia, in remission
C92.Z2 Other myeloid leukemia, in relapse
C92.90 Myeloid leukemia, unspecified, not having achieved remission
C92.91 Myeloid leukemia, unspecified in remission
C93.00 - C93.02 Acute monoblastic/monocytic leukemia, not having achieved remission - Acute monoblastic/monocytic leukemia, in relapse
C93.10 - C93.12 Chronic myelomonocytic leukemia not having achieved remission - Chronic myelomonocytic leukemia, in relapse
C93.30 - C93.32 Juvenile myelomonocytic leukemia, not having achieved remission - Juvenile myelomonocytic leukemia, in relapse
C93.Z0 Other monocytic leukemia, not having achieved remission
C93.Z1 Other monocytic leukemia, in remission
C93.Z2 Other monocytic leukemia, in relapse
C93.90 - C93.92 Monocytic leukemia, unspecified, not having achieved remission - Monocytic leukemia, unspecified in relapse
C94.00 - C94.02 Acute erythroid leukemia, not having achieved remission - Acute erythroid leukemia, in relapse
C94.20 - C94.22 Acute megakaryoblastic leukemia not having achieved remission - Acute megakaryoblastic leukemia, in relapse
C94.30 - C94.32 Mast cell leukemia not having achieved remission - Mast cell leukemia, in relapse
C94.80 - C94.82 Other specified leukemias not having achieved remission - Other specified leukemias, in relapse
C95.00 - C95.02 Acute leukemia of unspecified cell type not having achieved remission - Acute leukemia of unspecified cell type, in relapse
C95.10 - C95.12 Chronic leukemia of unspecified cell type not having achieved remission - Chronic leukemia of unspecified cell type, in relapse
C95.90 - C95.92 Leukemia, unspecified not having achieved remission - Leukemia, unspecified, in relapse
D45 Polycythemia vera
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
071x Clinic - Rural Health
072x Clinic - Hospital Based or Independent Renal Dialysis Center
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Revenue code 0636 relates to HCPCS code. Indicate HCPCS code J0885 in Form Locator 44 of the UB-04 form. The specified units of service to be reported are to be in thousands (1000s), rounded to the nearest thousand.

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.


Code Description
0634 Pharmacy - Erythropoietin (EPO)<10,000 units
0635 Pharmacy - Erythropoietin (EPO)>=10,000 Units
0636 Pharmacy - Drugs Requiring Detailed Coding
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R15

Revision Effective: 10/01/2023
Revision Explanation: Annual ICD -inserted Support Medical Necessity, the following code changes to D48.110 in D48.0 - D48.5 D48.111 in D48.0 - D48.5 D48.112 in D48.0 - D48.5 D48.113 in D48.0 - D48.5 D48.114 in D48.0 - D48.5 D48.115 in D48.0 - D48.5 D48.116 in D48.0 - D48.5 D48.117 in D48.0 - D48.5 D48.118 in D48.0 - D48.5 and D48.19 in D48.0 - D48.5 added to Group 4.

03/09/2023 R14

Revision Effective: 03/09/2023
Revision Explanation: Annual review, no changes 

05/12/2022 R13

Revision Effective: 05/12/2022
Revision Explanation: Removed the paragraph in article text related to GS modifier that was left in place in error after removing the modifier during revision 12.

04/07/2022 R12

Revision Effective: 04/07/2022
Revision Explanation: Updated article text. Added Q5105 and Q5106 to require value code to be reported and deleted details regarding modifiers EA, EE, and GS.

03/03/2022 R11

Revision Effective: 03/03/2022
Revision Explanation: Annual review, no changes were made.

10/01/2021 R10

Revision Effective: 10/01/2021
Revision Explanation: Annual ICD-10 update. Under ICD-10-CM Codes that Support Medical Necessity Group 4: Code added C79.63 and C84.7A.

07/08/2021 R9

R9
Revision Effective: 07/08/2021
Revision Explanation: In the ICD-10 codes that are not covered section the codes were listed in the paragraph section instead of the group 1 code list. These have been moved down to the correct section.

03/04/2021 R8

R8
Revision Effective: 03/04/2021
Revision Explanation: Annual review no changes were made.

10/01/2020 R7

R7
Revision Effective: 10/01/2020
Revision Explanation: During annual ICD-10 review added new code M05.7A to group 7.

10/01/2020 R6

R6
Revision Effective: 10/01/2020
Revision Explanation: During annual ICD-10 update N18.3 was deleted and replaced with N18.30-N18.32 in group 2.

01/23/2020 R5

Revision Effective: n/a

Revision Explanation: Annual review, no changes

 

01/23/2020 R4

R4

Revision Effective: 10/03/2019

Revision Explanation: Removed information that was added to the billing and coding article in error that was listed from section for CMS national coverage decision through limitations specified by CMS. This information was added to the article and removed from the policy in error. Please see policy for information from these sections.

01/23/2020 R3

R3

Revision Effective: 01/23/2020

Revision Explanation: In the section with header "Limitations as Specified by CMS", HCPCS code Q5106 was left out of the first sentence in error and has been added. 

01/02/2020 R2

R2

Revision Effective: 01/02/2020

Revision Explanation: Added regulations to the CMS National Policy section. Added text under article text concerning JA and JB modifier, definitions of ED and EE modifiers,corrected M32.11-M32.15 to M32.10-M32.15 under group 7 ICD-10, and corrected C92.20-C92.21 to C92.20 to C92.22 for myelogenous leukemias.

12/12/2019 R1

r1

Revision Effective: 12/12/2019

Revision Explanation: Added additional information under the section for general guidelines for submitting claims concerning reporting hematocrit or hemoglobin levels.

N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34356 - Erythropoiesis Stimulating Agents (ESA)
Related National Coverage Documents
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SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
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Public Versions
Updated On Effective Dates Status
11/08/2023 11/16/2023 - N/A Currently in Effect View
09/29/2023 10/01/2023 - 11/15/2023 Superseded You are here
02/28/2023 03/09/2023 - 09/30/2023 Superseded View
05/02/2022 05/12/2022 - 03/08/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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