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Article for Oral Anticancer Drugs - Policy Article - Effective June 2010 (August 2010 Revision) (A25619) This Article will be updated in the Medicare Coverage Database on August 19, 2010.
Contractor Information
Contractor Name back to top
CIGNA Government Services
Contractor Number back to top
18003
Contractor Type back to top
DME MAC
Article Information
Article ID Number back to top
A25619
Article Type back to top
Article
Key Article back to top
Yes
Article Title back to top
Oral Anticancer Drugs - Policy Article - Effective June 2010 (August 2010 Revision)
AMA CPT / ADA CDT Copyright Statement back to top
CPT codes, descriptions and other data only are copyright 2009 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association.© 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
Article Information
Primary Geographic Jurisdiction back to top
Alabama Arkansas Colorado Florida Georgia Louisiana Mississippi North Carolina New Mexico Oklahoma Puerto Rico South Carolina Tennessee Texas Virginia Virgin Islands West Virginia
DME Region Article Covers back to top
Jurisdiction C
Original Article Effective Date back to top
04/01/2005
Article Revision Effective Date back to top
06/01/2010
Article Text back to top
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES For an item to be covered by Medicare, a written signed and dated order must be received by the supplier before a claim is submitted. If the supplier bills for an item addressed in this policy without first receiving the completed order, the item will be denied as non-covered. Oral Anticancer Drugs For an oral anticancer drug to be covered, all of the following
Article Information
criteria (1-4) must be met:
1. It is a drug or biological that has been approved by the Food and Drug Administration (FDA), and
2. It has the same active ingredients as a non-self-administrable anticancer chemotherapeutic drug or biological that is covered when furnished incident to a physician's service. The oral anticancer drug and the non-self-administrable drug must have the same chemical/generic name as indicated by the FDA's Approved Drug Products (Orange Book), Physician's Desk Reference (PDR), or an authoritative drug compendium, or it is a prodrug which, when ingested, is metabolized into the same active ingredient which is found in the non-self-administrable form of the drug, and
3. It is used for the same anticancer chemotherapeutic indications, including unlabeled or “off’label” uses, as the non-self-administrable form of the drug, and
4. It is prescribed by a physician or other practitioner licensed under state law to prescribe such drugs as anticancer chemotherapeutic agents.
A drug that is not available in an injectable form does not meet criterion 2. If an oral anticancer drug is used for immunosuppression (rather than the treatment of cancer), criterion 3 is not met, and the drug cannot be covered under the oral anticancer drug benefit. (If the drug is used for immunosuppression following organ transplant, refer to the Immunosuppressive Drugs policy.) If criteria 1-4 are not met, the drug will be denied as non-covered. A claim denied for the reason that a diagnosis does not fall in the section below in this Policy Article titled “ICD-9 Codes that are Covered” will receive a statutory denial as non-covered, but may be covered at appeal if and only if it can be shown to be allowed under CMS IOM 100-02, Chapter 15, Section 50 – Drugs and Biologicals, and under the Social Security Act, Sec.1861(s)(Q).
Article Information
The quantity of oral anticancer drugs that is dispensed should be limited to a 30-day supply. Prescriptions may be refillable. Antiemetic Drugs Used With Oral Anticancer Drugs A self-administered antiemetic drug billed with code J8498 or J8597 is covered if all of the following criteria are met:
1. It is used in conjunction with a covered oral anticancer drug, and
2. It is likely that administration of the covered oral anticancer drug will induce emesis if the antiemetic drug is not administered, and
3. The antiemetic drug is administered within 2 hours before the covered oral anticancer drug is administered.
Antiemetic drugs are covered under the oral anticancer drug benefit for the sole purpose of allowing the absorption of the covered oral anticancer drug. Therefore, coverage is limited to doses of antiemetic drugs, which are administered during the two hours before administration of the covered oral anticancer drug. Doses of antiemetic drugs administered after the administration of the oral anticancer drug (e.g., to treat nausea or vomiting which is caused by the oral anticancer drug or other etiology) are non-covered. If all of the criteria are not met, the antiemetic drug will be denied as non-covered. For information on the coverage of oral antiemetic drugs when they are used as a full replacement for intravenous antiemetic drugs used in conjunction with intravenous cancer chemotherapeutic regimens, refer to the Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) policy. Supply Fee One unit of service of supply fee code Q0511 is covered for the first covered oral anticancer drug that is dispensed in a 30-day period. If covered drugs are dispensed by more than one
Article Information
pharmacy during a 30-day period, one unit of Q0511 is covered for each pharmacy. One unit of service of supply fee code Q0512 is covered for each subsequent covered oral anticancer drug that is dispensed in that 30-day period. If two dosage strengths of the same drug are dispensed on the same day, one unit of service of the appropriate supply fee is payable for each one. If more than one unit of service of code Q0511 is billed per 30 days by a single pharmacy, the excess units of service will be paid comparable to code Q0512. If the billed units of service of Q0511 or Q0512 exceed the number of drugs on the claim, the excess units will be denied as not separately payable. Supply fees are eligible for coverage only for drugs that are covered under this LCD. If the drug on the claim is denied as non-covered, the supply fee will be denied as non-covered. The supply fee code must be billed on the same claim as the drug(s). If it is not, the supply fee will be denied as incorrect billing. J8498 is not eligible for payment of a supply fee. CODING GUIDELINES For the instructions below that apply to J codes, when claims are billed in NCPDP format using NDC numbers, different instructions may apply. Refer to the NCPDP Companion Document available through the CMS web site. The National Drug Code (NDC) is a number, which uniquely identifies a manufacturer's product in terms of the strength of each tablet/capsule, quantity of tablets/capsules in a package, and other packaging details. Suppliers must use the NDC that matches the product dispensed. For all NDC numbers, 1 unit of service = 1 tablet or 1 capsule. For codes J8498 and J8597, 1 unit of service = 1 mg. National Drugs Codes (NDCs) may be billed only when the drug is used as an oral anticancer drug. If cyclophosphamide or
Article Information
methotrexate are prescribed as an oral immunosuppressive drug following an organ transplant, code J8530 or J8610 respectively must be used. (Refer to the Immunosuppressive Drugs policy for additional information.) If, for example, cyclophosphamide or methotrexate is prescribed as an oral immunosuppressive drug for other conditions (e.g., lupus, rheumatoid arthritis, etc.), a claim should not be submitted to Medicare (unless requested by the beneficiary; and in which case it would be submitted with a GY modifier) because there is no statutory benefit for oral immunosuppressive drugs in these conditions. Code J8498 or J8597 may be billed only when the antiemetic drug is used in conjunction with a covered oral anticancer drug. Suppliers may bill only for quantities of antiemetic drugs that are to be used within 2 hours before the covered oral anticancer drug. Refer to the Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) policy for information on billing oral antiemetics used in conjunction with intravenous cancer chemotherapeutic regimens. A list of valid NDC numbers for covered oral anticancer drugs can be found on the Pricing, Data Analysis and Coding (PDAC) Contractor web site. Until a new NDC number is added to the list, suppliers must submit claims using code J8999. Oral anticancer drugs which are not covered under the oral anticancer drug benefit (i.e., those that are not specifically listed in this policy) must be billed using code A9270 (noncovered item or service) if the supplier chooses to submit a claim. Suppliers should contact the PDAC for guidance on the correct coding of these items.
Coding Information
ICD-9 Codes that are Covered back to top
The presence of an ICD-9 code listed in this section is not sufficient by itself to assure coverage. Refer to the Non-Medical Necessity Coverage and Payment Rules section for other coverage criteria and payment information.
Coding Information
For Busulfan:
183.0 - 183.9
MALIGNANT NEOPLASM OF OVARY - MALIGNANT NEOPLASM OF UTERINE ADNEXA UNSPECIFIED SITE
200.00 - 200.88
RETICULOSARCOMA UNSPECIFIED SITE - OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
202.00 - 202.92
NODULAR LYMPHOMA UNSPECIFIED SITE - OTHER AND UNSPECIFIED MALIGNANT NEOPLASMS OF LYMPHOID AND HISTIOCYTIC TISSUE INVOLVING INTRATHORACIC LYMPH NODES
203.00 - 203.82
MULTIPLE MYELOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - OTHER IMMUNOPROLIFERATIVE NEOPLASMS, IN RELAPSE
205.00 - 205.92
ACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED MYELOID LEUKEMIA, IN RELAPSE
206.00 - 206.92
ACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED MONOCYTIC LEUKEMIA, IN RELAPSE
V10.43 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OVARY
V10.62 PERSONAL HISTORY OF MYELOID LEUKEMIA
V10.63 PERSONAL HISTORY OF MONOCYTIC LEUKEMIA
V10.71 PERSONAL HISTORY OF LYMPHOSARCOMA AND RETICULOSARCOMA
V10.79 PERSONAL HISTORY OF OTHER LYMPHATIC AND HEMATOPOIETIC NEOPLASMS
V42.81 BONE MARROW REPLACED BY TRANSPLANT For Capecitabine:
Coding Information
140.0 - 141.9
MALIGNANT NEOPLASM OF UPPER LIP VERMILION BORDER - MALIGNANT NEOPLASM OF TONGUE UNSPECIFIED
143.0 - 149.9
MALIGNANT NEOPLASM OF UPPER GUM - MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE LIP AND ORAL CAVITY
150.0 - 150.9
MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS - MALIGNANT NEOPLASM OF ESOPHAGUS UNSPECIFIED SITE
151.0 - 151.9
MALIGNANT NEOPLASM OF CARDIA - MALIGNANT NEOPLASM OF STOMACH UNSPECIFIED SITE
153.0 - 154.8
MALIGNANT NEOPLASM OF HEPATIC FLEXURE - MALIGNANT NEOPLASM OF OTHER SITES OF RECTUM RECTOSIGMOID JUNCTION AND ANUS
155.1 MALIGNANT NEOPLASM OF INTRAHEPATIC BILE DUCTS
156.0 - 156.9
MALIGNANT NEOPLASM OF GALLBLADDER - MALIGNANT NEOPLASM OF BILIARY TRACT PART UNSPECIFIED SITE
157.0 - 157.9
MALIGNANT NEOPLASM OF HEAD OF PANCREAS - MALIGNANT NEOPLASM OF PANCREAS PART UNSPECIFIED
158.8 MALIGNANT NEOPLASM OF SPECIFIED PARTS OF PERITONEUM
174.0 - 175.9
MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST
183.0 - 183.9
MALIGNANT NEOPLASM OF OVARY - MALIGNANT NEOPLASM OF UTERINE ADNEXA UNSPECIFIED SITE
197.0 SECONDARY MALIGNANT NEOPLASM OF LUNG
197.6 SECONDARY MALIGNANT NEOPLASM OF RETROPERITONEUM AND PERITONEUM
197.7 MALIGNANT NEOPLASM OF LIVER SECONDARY
Coding Information
198.3 SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD
198.5 SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW
235.2 NEOPLASM OF UNCERTAIN BEHAVIOR OF STOMACH INTESTINES AND RECTUM
235.5 NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER AND UNSPECIFIED DIGESTIVE ORGANS
V10.00 - V10.09
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF UNSPECIFIED SITE IN GASTROINTESTINAL TRACT - PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES IN GASTROINTESTINAL TRACT
V10.3 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST
V10.43 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OVARY
V10.88 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER ENDOCRINE GLANDS AND RELATED STRUCTURES
For Cyclophosphamide:
140.0 - 149.9
MALIGNANT NEOPLASM OF UPPER LIP VERMILION BORDER - MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE LIP AND ORAL CAVITY
151.0 - 151.9
MALIGNANT NEOPLASM OF CARDIA - MALIGNANT NEOPLASM OF STOMACH UNSPECIFIED SITE
158.8 MALIGNANT NEOPLASM OF SPECIFIED PARTS OF PERITONEUM
160.0 - 161.9
MALIGNANT NEOPLASM OF NASAL CAVITIES - MALIGNANT NEOPLASM OF LARYNX UNSPECIFIED
162.0 - 162.9
MALIGNANT NEOPLASM OF TRACHEA - MALIGNANT NEOPLASM OF BRONCHUS AND LUNG UNSPECIFIED
164.0 MALIGNANT NEOPLASM OF THYMUS
164.8 MALIGNANT NEOPLASM OF OTHER PARTS OF
Coding Information
MEDIASTINUM
170.0 - 170.9
MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE EXCEPT MANDIBLE - MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE SITE UNSPECIFIED
171.0 - 171.9
MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK - MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE SITE UNSPECIFIED
173.1 - 173.9
OTHER MALIGNANT NEOPLASM OF SKIN OF EYELID INCLUDING CANTHUS - OTHER MALIGNANT NEOPLASM OF SKIN SITE UNSPECIFIED
174.0 - 175.9
MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST
180.0 - 180.9
MALIGNANT NEOPLASM OF ENDOCERVIX - MALIGNANT NEOPLASM OF CERVIX UTERI UNSPECIFIED SITE
181 MALIGNANT NEOPLASM OF PLACENTA
182.0 - 182.8
MALIGNANT NEOPLASM OF CORPUS UTERI EXCEPT ISTHMUS - MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF BODY OF UTERUS
183.0 - 183.9
MALIGNANT NEOPLASM OF OVARY - MALIGNANT NEOPLASM OF UTERINE ADNEXA UNSPECIFIED SITE
185 MALIGNANT NEOPLASM OF PROSTATE
186.0 - 186.9
MALIGNANT NEOPLASM OF UNDESCENDED TESTIS - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED TESTIS
188.0 - 188.9
MALIGNANT NEOPLASM OF TRIGONE OF URINARY BLADDER - MALIGNANT NEOPLASM OF BLADDER PART UNSPECIFIED
189.0 - 189.1
MALIGNANT NEOPLASM OF KIDNEY EXCEPT PELVIS - MALIGNANT NEOPLASM OF RENAL PELVIS
190.5 MALIGNANT NEOPLASM OF RETINA
191.0 - MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES
Coding Information
191.9 AND VENTRICLES - MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE
192.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF NERVOUS SYSTEM
194.0 MALIGNANT NEOPLASM OF ADRENAL GLAND
195.0 MALIGNANT NEOPLASM OF HEAD FACE AND NECK
197.0 SECONDARY MALIGNANT NEOPLASM OF LUNG
197.7 MALIGNANT NEOPLASM OF LIVER SECONDARY
198.3 SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD
198.5 SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW
198.7 SECONDARY MALIGNANT NEOPLASM OF ADRENAL GLAND
200.00 - 200.88
RETICULOSARCOMA UNSPECIFIED SITE - OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
201.00 - 201.98
HODGKIN'S PARAGRANULOMA UNSPECIFIED SITE - HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING LYMPH NODES OF MULTIPLE SITES
202.00 - 202.98
NODULAR LYMPHOMA UNSPECIFIED SITE - OTHER AND UNSPECIFIED MALIGNANT NEOPLASMS OF LYMPHOID AND HISTIOCYTIC TISSUE INVOLVING LYMPH NODES OF MULTIPLE SITES
203.00 - 203.82
MULTIPLE MYELOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - OTHER IMMUNOPROLIFERATIVE NEOPLASMS, IN RELAPSE
204.00 - 204.92
ACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED LYMPHOID LEUKEMIA, IN RELAPSE
205.00 - 205.92
ACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED MYELOID LEUKEMIA, IN RELAPSE
Coding Information
206.00 - 206.92
ACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED MONOCYTIC LEUKEMIA, IN RELAPSE
209.30 - 209.36
MALIGNANT POORLY DIFFERENTIATED NEUROENDOCRINE CARCINOMA, ANY SITE - MERKEL CELL CARCINOMA OF OTHER SITES
209.75 SECONDARY MERKEL CELL CARCINOMA
211.1 BENIGN NEOPLASM OF STOMACH
212.6 BENIGN NEOPLASM OF THYMUS
219.0 BENIGN NEOPLASM OF CERVIX UTERI
236.1 NEOPLASM OF UNCERTAIN BEHAVIOR OF PLACENTA
238.6 NEOPLASM OF UNCERTAIN BEHAVIOR OF PLASMA CELLS
239.2 NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT TISSUE AND SKIN
273.2 OTHER PARAPROTEINEMIAS
273.3 MACROGLOBULINEMIA
277.30 AMYLOIDOSIS, UNSPECIFIED
998.9 UNSPECIFIED COMPLICATION OF PROCEDURE NOT ELSEWHERE CLASSIFIED
V10.01 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF TONGUE
V10.02 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED PARTS OF ORAL CAVITY AND PHARYNX
V10.04 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF STOMACH
V10.11 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BRONCHUS AND LUNG
V10.3 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST
V10.40 - PERSONAL HISTORY OF MALIGNANT NEOPLASM OF
Coding Information
V10.48 UNSPECIFIED FEMALE GENITAL ORGAN - PERSONAL HISTORY OF MALIGNANT NEOPLASM OF EPIDIDYMIS
V10.51 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BLADDER
V10.53 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF RENAL PELVIS
V10.61 PERSONAL HISTORY OF LYMPHOID LEUKEMIA
V10.62 PERSONAL HISTORY OF MYELOID LEUKEMIA
V10.63 PERSONAL HISTORY OF MONOCYTIC LEUKEMIA
V10.71 PERSONAL HISTORY OF LYMPHOSARCOMA AND RETICULOSARCOMA
V10.72 PERSONAL HISTORY OF HODGKIN'S DISEASE
V10.79 PERSONAL HISTORY OF OTHER LYMPHATIC AND HEMATOPOIETIC NEOPLASMS
V10.81 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BONE
V10.83 PERSONAL HISTORY OF OTHER MALIGNANT NEOPLASM OF SKIN
V10.84 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF EYE
V10.85 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BRAIN
V10.88 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER ENDOCRINE GLANDS AND RELATED STRUCTURES
V10.89 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES
V10.91 PERSONAL HISTORY OF MALIGNANT NEUROENDOCRINE TUMOR
V42.81 BONE MARROW REPLACED BY TRANSPLANT For Etoposide:
150.0 - MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS -
Coding Information
150.9 MALIGNANT NEOPLASM OF ESOPHAGUS UNSPECIFIED SITE
151.0 - 151.9
MALIGNANT NEOPLASM OF CARDIA - MALIGNANT NEOPLASM OF STOMACH UNSPECIFIED SITE
155.0 - 155.2
MALIGNANT NEOPLASM OF LIVER PRIMARY - MALIGNANT NEOPLASM OF LIVER NOT SPECIFIED AS PRIMARY OR SECONDARY
157.4 MALIGNANT NEOPLASM OF ISLETS OF LANGERHANS
158.8 - 158.9
MALIGNANT NEOPLASM OF SPECIFIED PARTS OF PERITONEUM - MALIGNANT NEOPLASM OF PERITONEUM UNSPECIFIED
160.0 - 160.9
MALIGNANT NEOPLASM OF NASAL CAVITIES - MALIGNANT NEOPLASM OF ACCESSORY SINUS UNSPECIFIED
162.0 - 162.9
MALIGNANT NEOPLASM OF TRACHEA - MALIGNANT NEOPLASM OF BRONCHUS AND LUNG UNSPECIFIED
163.0 - 163.9
MALIGNANT NEOPLASM OF PARIETAL PLEURA - MALIGNANT NEOPLASM OF PLEURA UNSPECIFIED
164.0 MALIGNANT NEOPLASM OF THYMUS
164.1 - 164.9
MALIGNANT NEOPLASM OF HEART - MALIGNANT NEOPLASM OF MEDIASTINUM PART UNSPECIFIED
165.8 MALIGNANT NEOPLASM OF OTHER SITES WITHIN THE RESPIRATORY SYSTEM AND INTRATHORACIC ORGANS
170.0 - 170.9
MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE EXCEPT MANDIBLE - MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE SITE UNSPECIFIED
171.0 - 171.9
MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK - MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE SITE UNSPECIFIED
174.0 - 175.9
MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST
176.0 - KAPOSI'S SARCOMA SKIN - KAPOSI'S SARCOMA
Coding Information
176.9 UNSPECIFIED SITE
180.0 - 180.9
MALIGNANT NEOPLASM OF ENDOCERVIX - MALIGNANT NEOPLASM OF CERVIX UTERI UNSPECIFIED SITE
181 MALIGNANT NEOPLASM OF PLACENTA
182.0 - 182.8
MALIGNANT NEOPLASM OF CORPUS UTERI EXCEPT ISTHMUS - MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF BODY OF UTERUS
183.0 - 183.9
MALIGNANT NEOPLASM OF OVARY - MALIGNANT NEOPLASM OF UTERINE ADNEXA UNSPECIFIED SITE
184.4 MALIGNANT NEOPLASM OF VULVA UNSPECIFIED SITE
185 MALIGNANT NEOPLASM OF PROSTATE
186.0 - 186.9
MALIGNANT NEOPLASM OF UNDESCENDED TESTIS - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED TESTIS
188.0 - 188.9
MALIGNANT NEOPLASM OF TRIGONE OF URINARY BLADDER - MALIGNANT NEOPLASM OF BLADDER PART UNSPECIFIED
189.0 - 189.1
MALIGNANT NEOPLASM OF KIDNEY EXCEPT PELVIS - MALIGNANT NEOPLASM OF RENAL PELVIS
190.5 MALIGNANT NEOPLASM OF RETINA
191.0 - 191.9
MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES - MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE
192.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF NERVOUS SYSTEM
193 MALIGNANT NEOPLASM OF THYROID GLAND
194.0 MALIGNANT NEOPLASM OF ADRENAL GLAND
197.0 SECONDARY MALIGNANT NEOPLASM OF LUNG
197.7 MALIGNANT NEOPLASM OF LIVER SECONDARY
198.3 SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD
Coding Information
198.5 SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW
198.7 SECONDARY MALIGNANT NEOPLASM OF ADRENAL GLAND
199.0 - 199.2
DISSEMINATED MALIGNANT NEOPLASM - MALIGNANT NEOPLASM ASSOCIATED WITH TRANSPLANT ORGAN
200.00 - 200.88
RETICULOSARCOMA UNSPECIFIED SITE - OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
201.00 - 201.98
HODGKIN'S PARAGRANULOMA UNSPECIFIED SITE - HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING LYMPH NODES OF MULTIPLE SITES
202.00 - 202.98
NODULAR LYMPHOMA UNSPECIFIED SITE - OTHER AND UNSPECIFIED MALIGNANT NEOPLASMS OF LYMPHOID AND HISTIOCYTIC TISSUE INVOLVING LYMPH NODES OF MULTIPLE SITES
203.00 - 203.82
MULTIPLE MYELOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - OTHER IMMUNOPROLIFERATIVE NEOPLASMS, IN RELAPSE
204.00 - 204.92
ACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED LYMPHOID LEUKEMIA, IN RELAPSE
205.00 - 205.02
ACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - ACUTE MYELOID LEUKEMIA, IN RELAPSE
205.20 - 205.22
SUBACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - SUBACUTE MYELOID LEUKEMIA, IN RELAPSE
206.00 - 206.02
ACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - ACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
206.20 - 206.22
SUBACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - SUBACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
Coding Information
209.21 MALIGNANT CARCINOID TUMOR OF THE BRONCHUS AND LUNG
209.30 MALIGNANT POORLY DIFFERENTIATED NEUROENDOCRINE CARCINOMA, ANY SITE
209.31 - 209.36
MERKEL CELL CARCINOMA OF THE FACE - MERKEL CELL CARCINOMA OF OTHER SITES
209.75 SECONDARY MERKEL CELL CARCINOMA
212.6 BENIGN NEOPLASM OF THYMUS
236.1 NEOPLASM OF UNCERTAIN BEHAVIOR OF PLACENTA
237.5 NEOPLASM OF UNCERTAIN BEHAVIOR OF BRAIN AND SPINAL CORD
238.6 NEOPLASM OF UNCERTAIN BEHAVIOR OF PLASMA CELLS
V10.03 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF ESOPHAGUS
V10.04 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF STOMACH
V10.07 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LIVER
V10.11 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BRONCHUS AND LUNG
V10.3 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST
V10.40 - V10.44
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF UNSPECIFIED FEMALE GENITAL ORGAN - PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER FEMALE GENITAL ORGANS
V10.46 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF PROSTATE
V10.47 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF TESTIS
V10.51 - V10.53
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BLADDER - PERSONAL HISTORY OF MALIGNANT
Coding Information
NEOPLASM OF RENAL PELVIS
V10.63 PERSONAL HISTORY OF MONOCYTIC LEUKEMIA
V10.71 PERSONAL HISTORY OF LYMPHOSARCOMA AND RETICULOSARCOMA
V10.72 PERSONAL HISTORY OF HODGKIN'S DISEASE
V10.79 PERSONAL HISTORY OF OTHER LYMPHATIC AND HEMATOPOIETIC NEOPLASMS
V10.81 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BONE
V10.84 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF EYE
V10.85 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BRAIN
V10.87 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF THYROID
V10.88 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER ENDOCRINE GLANDS AND RELATED STRUCTURES
V10.89 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES
V10.91 PERSONAL HISTORY OF MALIGNANT NEUROENDOCRINE TUMOR
V42.81 BONE MARROW REPLACED BY TRANSPLANT For Fludarabine Phosphate:
200.00 - 200.88
RETICULOSARCOMA UNSPECIFIED SITE - OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
201.00 - 201.98
HODGKIN'S PARAGRANULOMA UNSPECIFIED SITE - HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING LYMPH NODES OF MULTIPLE SITES
202.00 - 202.98
NODULAR LYMPHOMA UNSPECIFIED SITE - OTHER AND UNSPECIFIED MALIGNANT NEOPLASMS OF LYMPHOID AND HISTIOCYTIC TISSUE INVOLVING
Coding Information
LYMPH NODES OF MULTIPLE SITES
204.10 - 204.12
CHRONIC LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - CHRONIC LYMPHOID LEUKEMIA, IN RELAPSE
204.90 - 204.92
UNSPECIFIED LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED LYMPHOID LEUKEMIA, IN RELAPSE
205.00 - 205.02
ACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - ACUTE MYELOID LEUKEMIA, IN RELAPSE
205.20 - 205.22
SUBACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - SUBACUTE MYELOID LEUKEMIA, IN RELAPSE
206.00 - 206.02
ACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - ACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
206.20 - 206.22
SUBACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - SUBACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
273.3 MACROGLOBULINEMIA
V10.61 - V10.63
PERSONAL HISTORY OF LYMPHOID LEUKEMIA - PERSONAL HISTORY OF MONOCYTIC LEUKEMIA
V10.71 PERSONAL HISTORY OF LYMPHOSARCOMA AND RETICULOSARCOMA
V10.72 PERSONAL HISTORY OF HODGKIN'S DISEASE
V10.79 PERSONAL HISTORY OF OTHER LYMPHATIC AND HEMATOPOIETIC NEOPLASMS
V42.81 BONE MARROW REPLACED BY TRANSPLANT For Mellphalan:
150.0 - 159.9
MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS - MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE DIGESTIVE ORGANS AND PERITONEUM
170.0 - MALIGNANT NEOPLASM OF BONES OF SKULL AND
Coding Information
170.9 FACE EXCEPT MANDIBLE - MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE SITE UNSPECIFIED
171.0 - 171.9
MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK - MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE SITE UNSPECIFIED
172.0 - 172.9
MALIGNANT MELANOMA OF SKIN OF LIP - MELANOMA OF SKIN SITE UNSPECIFIED
174.0 - 175.9
MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST
182.0 - 182.8
MALIGNANT NEOPLASM OF CORPUS UTERI EXCEPT ISTHMUS - MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF BODY OF UTERUS
183.0 - 183.9
MALIGNANT NEOPLASM OF OVARY - MALIGNANT NEOPLASM OF UTERINE ADNEXA UNSPECIFIED SITE
185 MALIGNANT NEOPLASM OF PROSTATE
186.0 - 186.9
MALIGNANT NEOPLASM OF UNDESCENDED TESTIS - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED TESTIS
198.5 SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW
201.00 - 201.98
HODGKIN'S PARAGRANULOMA UNSPECIFIED SITE - HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING LYMPH NODES OF MULTIPLE SITES
203.00 - 203.82
MULTIPLE MYELOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - OTHER IMMUNOPROLIFERATIVE NEOPLASMS, IN RELAPSE
205.10 - 205.12
CHRONIC MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - CHRONIC MYELOID LEUKEMIA, IN RELAPSE
206.10 - 206.12
CHRONIC MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - CHRONIC MONOCYTIC LEUKEMIA, IN RELAPSE
238.6 NEOPLASM OF UNCERTAIN BEHAVIOR OF PLASMA
Coding Information
CELLS
273.3 MACROGLOBULINEMIA
277.30 AMYLOIDOSIS, UNSPECIFIED
V10.03 - V10.09
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF ESOPHAGUS - PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES IN GASTROINTESTINAL TRACT
V10.3 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST
V10.42 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER PARTS OF UTERUS
V10.43 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OVARY
V10.46 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF PROSTATE
V10.47 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF TESTIS
V10.62 PERSONAL HISTORY OF MYELOID LEUKEMIA
V10.63 PERSONAL HISTORY OF MONOCYTIC LEUKEMIA
V10.72 PERSONAL HISTORY OF HODGKIN'S DISEASE
V10.81 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BONE
V10.82 PERSONAL HISTORY OF MALIGNANT MELANOMA OF SKIN
V42.81 BONE MARROW REPLACED BY TRANSPLANT For Methotrexate:
140.0 - 149.9
MALIGNANT NEOPLASM OF UPPER LIP VERMILION BORDER - MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE LIP AND ORAL CAVITY
150.0 - 150.9
MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS - MALIGNANT NEOPLASM OF ESOPHAGUS UNSPECIFIED SITE
Coding Information
151.0 - 151.9
MALIGNANT NEOPLASM OF CARDIA - MALIGNANT NEOPLASM OF STOMACH UNSPECIFIED SITE
153.0 - 154.8
MALIGNANT NEOPLASM OF HEPATIC FLEXURE - MALIGNANT NEOPLASM OF OTHER SITES OF RECTUM RECTOSIGMOID JUNCTION AND ANUS
155.0 - 155.2
MALIGNANT NEOPLASM OF LIVER PRIMARY - MALIGNANT NEOPLASM OF LIVER NOT SPECIFIED AS PRIMARY OR SECONDARY
157.0 - 157.9
MALIGNANT NEOPLASM OF HEAD OF PANCREAS - MALIGNANT NEOPLASM OF PANCREAS PART UNSPECIFIED
158.8 - 158.9
MALIGNANT NEOPLASM OF SPECIFIED PARTS OF PERITONEUM - MALIGNANT NEOPLASM OF PERITONEUM UNSPECIFIED
160.0 - 161.9
MALIGNANT NEOPLASM OF NASAL CAVITIES - MALIGNANT NEOPLASM OF LARYNX UNSPECIFIED
162.0 - 162.9
MALIGNANT NEOPLASM OF TRACHEA - MALIGNANT NEOPLASM OF BRONCHUS AND LUNG UNSPECIFIED
163.0 - 163.9
MALIGNANT NEOPLASM OF PARIETAL PLEURA - MALIGNANT NEOPLASM OF PLEURA UNSPECIFIED
164.1 - 164.9
MALIGNANT NEOPLASM OF HEART - MALIGNANT NEOPLASM OF MEDIASTINUM PART UNSPECIFIED
165.8 MALIGNANT NEOPLASM OF OTHER SITES WITHIN THE RESPIRATORY SYSTEM AND INTRATHORACIC ORGANS
170.0 - 170.9
MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE EXCEPT MANDIBLE - MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE SITE UNSPECIFIED
171.0 - 171.9
MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK - MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE SITE UNSPECIFIED
173.0 OTHER MALIGNANT NEOPLASM OF SKIN OF LIP
174.0 - 175.9
MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST
Coding Information
180.0 - 180.9
MALIGNANT NEOPLASM OF ENDOCERVIX - MALIGNANT NEOPLASM OF CERVIX UTERI UNSPECIFIED SITE
181 MALIGNANT NEOPLASM OF PLACENTA
183.0 - 183.9
MALIGNANT NEOPLASM OF OVARY - MALIGNANT NEOPLASM OF UTERINE ADNEXA UNSPECIFIED SITE
185 MALIGNANT NEOPLASM OF PROSTATE
186.0 - 186.9
MALIGNANT NEOPLASM OF UNDESCENDED TESTIS - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED TESTIS
187.1 - 187.4
MALIGNANT NEOPLASM OF PREPUCE - MALIGNANT NEOPLASM OF PENIS PART UNSPECIFIED
187.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF MALE GENITAL ORGANS
188.0 - 188.9
MALIGNANT NEOPLASM OF TRIGONE OF URINARY BLADDER - MALIGNANT NEOPLASM OF BLADDER PART UNSPECIFIED
189.1 - 189.8
MALIGNANT NEOPLASM OF RENAL PELVIS - MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF URINARY ORGANS
190.0 MALIGNANT NEOPLASM OF EYEBALL EXCEPT CONJUNCTIVA CORNEA RETINA AND CHOROID
190.5 MALIGNANT NEOPLASM OF RETINA
190.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF EYE
191.0 - 191.9
MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES - MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE
195.0 MALIGNANT NEOPLASM OF HEAD FACE AND NECK
198.3 SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD
198.4 - 198.5
SECONDARY MALIGNANT NEOPLASM OF OTHER PARTS OF NERVOUS SYSTEM - SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW
Coding Information
200.00 - 202.98
RETICULOSARCOMA UNSPECIFIED SITE - OTHER AND UNSPECIFIED MALIGNANT NEOPLASMS OF LYMPHOID AND HISTIOCYTIC TISSUE INVOLVING LYMPH NODES OF MULTIPLE SITES
204.00 - 204.92
ACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED LYMPHOID LEUKEMIA, IN RELAPSE
205.00 - 205.92
ACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED MYELOID LEUKEMIA, IN RELAPSE
206.00 - 206.92
ACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED MONOCYTIC LEUKEMIA, IN RELAPSE
233.7 CARCINOMA IN SITU OF BLADDER
235.1 NEOPLASM OF UNCERTAIN BEHAVIOR OF LIP ORAL CAVITY AND PHARYNX
235.6 NEOPLASM OF UNCERTAIN BEHAVIOR OF LARYNX
236.1 NEOPLASM OF UNCERTAIN BEHAVIOR OF PLACENTA
238.1 NEOPLASM OF UNCERTAIN BEHAVIOR OF CONNECTIVE AND OTHER SOFT TISSUE
V10.00 - V10.09
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF UNSPECIFIED SITE IN GASTROINTESTINAL TRACT - PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES IN GASTROINTESTINAL TRACT
V10.11 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BRONCHUS AND LUNG
V10.21 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LARYNX
V10.22 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF NASAL CAVITIES MIDDLE EAR AND ACCESSORY SINUSES
V10.3 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST
V10.41 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF
Coding Information
CERVIX UTERI
V10.43 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OVARY
V10.47 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF TESTIS
V10.49 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER MALE GENITAL ORGANS
V10.50 - V10.59
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF UNSPECIFIED URINARY ORGAN - PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER URINARY ORGANS
V10.61 - V10.63
PERSONAL HISTORY OF LYMPHOID LEUKEMIA - PERSONAL HISTORY OF MONOCYTIC LEUKEMIA
V10.71 PERSONAL HISTORY OF LYMPHOSARCOMA AND RETICULOSARCOMA
V10.72 PERSONAL HISTORY OF HODGKIN'S DISEASE
V10.79 PERSONAL HISTORY OF OTHER LYMPHATIC AND HEMATOPOIETIC NEOPLASMS
V10.81 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BONE
V10.85 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BRAIN
V10.88 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER ENDOCRINE GLANDS AND RELATED STRUCTURES
V10.89 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES
For Temozolomide:
157.4 MALIGNANT NEOPLASM OF ISLETS OF LANGERHANS
158.0 - 158.9
MALIGNANT NEOPLASM OF RETROPERITONEUM - MALIGNANT NEOPLASM OF PERITONEUM UNSPECIFIED
162.0 - MALIGNANT NEOPLASM OF TRACHEA - MALIGNANT
Coding Information
162.9 NEOPLASM OF BRONCHUS AND LUNG UNSPECIFIED
170.0 - 170.9
MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE EXCEPT MANDIBLE - MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE SITE UNSPECIFIED
171.0 - 171.9
MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK - MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE SITE UNSPECIFIED
172.0 - 172.9
MALIGNANT MELANOMA OF SKIN OF LIP - MELANOMA OF SKIN SITE UNSPECIFIED
191.0 - 191.9
MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES - MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE
192.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF NERVOUS SYSTEM
192.9 MALIGNANT NEOPLASM OF NERVOUS SYSTEM PART UNSPECIFIED
197.0 SECONDARY MALIGNANT NEOPLASM OF LUNG
197.7 MALIGNANT NEOPLASM OF LIVER SECONDARY
198.3 SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD
198.5 SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW
199.0 DISSEMINATED MALIGNANT NEOPLASM
199.1 OTHER MALIGNANT NEOPLASM OF UNSPECIFIED SITE
200.50 - 200.51
PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, UNSPECIFIED SITE, EXTRANODAL AND SOLID ORGAN SITES - PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
204.00 - 204.02
ACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - ACUTE LYMPHOID LEUKEMIA, IN RELAPSE
204.20 - SUBACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION
Coding Information
204.22 OF HAVING ACHIEVED REMISSION - SUBACUTE LYMPHOID LEUKEMIA, IN RELAPSE
205.00 - 205.02
ACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - ACUTE MYELOID LEUKEMIA, IN RELAPSE
205.20 - 205.22
SUBACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - SUBACUTE MYELOID LEUKEMIA, IN RELAPSE
206.00 - 206.02
ACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - ACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
206.20 - 206.22
SUBACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - SUBACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
237.5 NEOPLASM OF UNCERTAIN BEHAVIOR OF BRAIN AND SPINAL CORD
239.2 NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT TISSUE AND SKIN
V10.09 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES IN GASTROINTESTINAL TRACT
V10.11 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BRONCHUS AND LUNG
V10.61 PERSONAL HISTORY OF LYMPHOID LEUKEMIA
V10.62 PERSONAL HISTORY OF MYELOID LEUKEMIA
V10.63 PERSONAL HISTORY OF MONOCYTIC LEUKEMIA
V10.81 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BONE
V10.82 PERSONAL HISTORY OF MALIGNANT MELANOMA OF SKIN
V10.85 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BRAIN
V10.88 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER ENDOCRINE GLANDS AND RELATED STRUCTURES
Coding Information
V10.89 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES
For Topotecan:
153.0 - 154.8
MALIGNANT NEOPLASM OF HEPATIC FLEXURE - MALIGNANT NEOPLASM OF OTHER SITES OF RECTUM RECTOSIGMOID JUNCTION AND ANUS
158.8 MALIGNANT NEOPLASM OF SPECIFIED PARTS OF PERITONEUM
162.0 - 162.9
MALIGNANT NEOPLASM OF TRACHEA - MALIGNANT NEOPLASM OF BRONCHUS AND LUNG UNSPECIFIED
170.0 - 171.9
MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE EXCEPT MANDIBLE - MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE SITE UNSPECIFIED
174.0 - 175.9
MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST
180.0 - 180.9
MALIGNANT NEOPLASM OF ENDOCERVIX - MALIGNANT NEOPLASM OF CERVIX UTERI UNSPECIFIED SITE
182.0 - 182.8
MALIGNANT NEOPLASM OF CORPUS UTERI EXCEPT ISTHMUS - MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF BODY OF UTERUS
183.0 - 183.9
MALIGNANT NEOPLASM OF OVARY - MALIGNANT NEOPLASM OF UTERINE ADNEXA UNSPECIFIED SITE
185 MALIGNANT NEOPLASM OF PROSTATE
188.0 - 188.9
MALIGNANT NEOPLASM OF TRIGONE OF URINARY BLADDER - MALIGNANT NEOPLASM OF BLADDER PART UNSPECIFIED
189.0 - 189.2
MALIGNANT NEOPLASM OF KIDNEY EXCEPT PELVIS - MALIGNANT NEOPLASM OF URETER
191.0 - 191.9
MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES - MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE
197.0 SECONDARY MALIGNANT NEOPLASM OF LUNG
Coding Information
197.7 MALIGNANT NEOPLASM OF LIVER SECONDARY
198.3 SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD
198.5 SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW
198.7 SECONDARY MALIGNANT NEOPLASM OF ADRENAL GLAND
200.50 - 200.51
PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, UNSPECIFIED SITE, EXTRANODAL AND SOLID ORGAN SITES - PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
203.00 - 203.82
MULTIPLE MYELOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - OTHER IMMUNOPROLIFERATIVE NEOPLASMS, IN RELAPSE
204.00 - 205.92
ACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED MYELOID LEUKEMIA, IN RELAPSE
206.00 - 206.02
ACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - ACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
206.20 - 206.22
SUBACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - SUBACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
209.30 MALIGNANT POORLY DIFFERENTIATED NEUROENDOCRINE CARCINOMA, ANY SITE
209.31 - 209.36
MERKEL CELL CARCINOMA OF THE FACE - MERKEL CELL CARCINOMA OF OTHER SITES
209.75 SECONDARY MERKEL CELL CARCINOMA
238.71 - 238.76
ESSENTIAL THROMBOCYTHEMIA - MYELOFIBROSIS WITH MYELOID METAPLASIA
238.9 NEOPLASM OF UNCERTAIN BEHAVIOR SITE UNSPECIFIED
V10.05 -
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LARGE INTESTINE - PERSONAL HISTORY OF
Coding Information
V10.06 MALIGNANT NEOPLASM OF RECTUM RECTOSIGMOID JUNCTION AND ANUS
V10.11 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BRONCHUS AND LUNG
V10.3 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST
V10.41 - V10.43
PERSONAL HISTORY OF MALIGNANT NEOPLASM OF CERVIX UTERI - PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OVARY
V10.51 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BLADDER
V10.61 PERSONAL HISTORY OF LYMPHOID LEUKEMIA
V10.62 PERSONAL HISTORY OF MYELOID LEUKEMIA
V10.63 PERSONAL HISTORY OF MONOCYTIC LEUKEMIA
V10.81 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BONE
V10.85 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BRAIN
V10.89 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES
V10.91 PERSONAL HISTORY OF MALIGNANT NEUROENDOCRINE TUMOR
V16.49 FAMILY HISTORY OF MALIGNANT NEOPLASM OF OTHER
ICD-9 Codes that are Not Covered back to top
All codes not listed in the previous section.
No Coding Information has been entered in this section of the article.
Other Information
Other Information
Revision History Explanation back to top
Revision Effective Date: 06/01/2010 (August Publication) ICD-9 CODES THAT ARE COVERED: Added: Multiple diagnoses for all the drugs Revision Effective Date: 06/01/2010 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Clarified: Criterion 3 to indicate coverage for those ICD-9 diagnoses specifically indicated under IOM 100-02, Section 50 – Drugs and Biologicals and under the Social Security Act, Sec.1861(s)(Q). Added: Coverage possible at appeal for claims not listed in the section “ICD-9 Codes that are Covered ” which can be shown consistent with IOM 100-02, Section 50 – Drugs and Biologicals and with the Social Security Act, Sec.1861(s)(Q). ICD-9 CODES THAT ARE COVERED: Changed: All ICD-9 diagnoses to those specifically indicated under IOM 100-02, Section 50 – Drugs and Biologicals and under the Social Security Act, Sec.1861(s)(Q). Added: Diagnoses for fludarabine phosphate (effective 1/01/2010). Revision Effective Date: 10/01/2009 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Added: 208.92-209.36, 209.70-209.79 to accepted diagnoses for busulfan, capecitabine, cyclophosphamide, etoposide, melphalan, methotrexate, or temozolomide CODING GUIDELINES: Changed: SADMERC to PDAC ICD-9 CODES THAT ARE COVERED: Added: 208.92-209.36, 209.70-209.79 to accepted diagnoses for busulfan, capecitabine, cyclophosphamide, etoposide, melphalan, methotrexate, or temozolomide 08/08/2009 - This article was updated by the ICD-9 2009-2010 Annual Update. 08/10/2008 - This policy was updated by the ICD-9 2008-2009 Annual Update. Revision Effective Date: 04/01/2008 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES:
Other Information
Expanded: Range of payable codes. Added: V58.11 ICD-9 CODES THAT ARE COVERED: Removed: V58.0-V58.10, V58.12. Added: Topotecan. Added: ICD-9 codes 162.2-162.9 for Topotecan 03/01/2008 - In accordance with Section 911 of the Medicare Modernization Act, this policy was transitioned to DME MAC CIGNA Government Services (18003) Article A25619 from DME PSC TrustSolutions (77012) Article A25619. 09/03/2007 - This article was updated by the ICD-9 2007-2008 Annual Update. Revision Effective Date: 07/01/2007 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Removed: DMERC references CODING GUIDELINES: Removed: DMERC references 06/01/2007 - In accordance with Section 911 of the Medicare Modernization Act of 2003, Virginia and West Virginia were transitioned from DME PSC TriCenturion (77011) to DME PSC TrustSolutions (77012). Revision Effective Date: 01/01/2007 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Specified that the quantity of drugs dispensed should be limited to a one month supply. Removed: DMERC references CODING GUIDELINES: Removed: DMERC references ICD-9 CODES THAT ARE COVERED: Expanded range of payable codes. Added: V58.0 – V58.12. 03/01/2006 - In accordance with Section 911 of the Medicare Modernization Act of 2003, this article was transitioned to DME PSC TrustSolutions (77012) from DMERC Palmetto GBA (00885). Revision Effective Date: 01/01/2006
Other Information
NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Edited for Code changes Revised instructions for Supply Fee CODING GUIDELINES: Added: J8498 and J8597 Deleted: K0415 and K0416 Revision Effective Date: 10/01/2005 NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Revised supply fee coverage for multiple dosage forms of the same drug. Effective Date: 04/01/2005 LMRP converted to LCD and Policy Article NON-MEDICAL NECESSITY COVERAGE AND PAYMENT RULES: Added: G0370 and instructions CODING GUIDELINES: Added: Instructions about the use of NDC numbers. ICD-9 CODES THAT ARE COVERED: Expanded range of payable codes
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