LCD Reference Article Billing and Coding Article

Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

A59215

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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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Source Article ID
N/A
Article ID
A59215
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin
Article Type
Billing and Coding
Original Effective Date
02/19/2023
Revision Effective Date
10/01/2024
Revision Ending Date
N/A
Retirement Date
N/A

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CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 3, §90.3.1 Allogeneic for Stem Cell Transplantation

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §110.23 Stem Cell Transplantation

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 25, §75 General Instructions for Completion of Form CMS-1450 for Billing

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin DL39434.

The CMS National Coverage Determination (NCD 110.23) for Stem Cell Transplantation describes nationally covered indications for stem cell transplant, the details of which will not be repeated within this article. This article describes additional locally covered indications for stem cell transplant.

The following evaluation is recommended to determine if the patient is an appropriate candidate for the procedure. A pretransplant assessment should establish the extent of disease and provide information about the individual's comorbidities that are likely to impact outcomes. This assessment varies by institution.

It is expected that documentation of the pretransplant evaluation be included in the documentation maintained for the transplant’s billing and be available on request.

The evaluation should include a significant portion of the following elements or documentation of the completion of the institution’s pre-established pre-transplant protocol, demonstrating the elements of that protocol.

  • Detailed history
  • Physical examination
  • Laboratory studies
  • A chest radiograph, an electrocardiogram, and a study of cardiac function
  • Pulmonary function test
  • Disease-specific restaging studies
  • Functional status assessment
  • Risk assessment for allogenic transplant (multiple scoring systems are available the European Group for Blood and Marrow Transplantation (EMBMT) is commonly used.1
  • Co-morbidity assessment (multiple scoring systems are available the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) is commonly used.1
  • Further studies may be required depending on signs and symptoms.

PRETRANSPLANT COUNSELING (1)

This A/B MAC suggests the following:

  • Fertility preservation
  • End-of-life and advance care planning
  • Informed consent guidelines mandate that patients have an accurate understanding of the risks of HCT.

Reference:

  1. Deeg HJ, Sandmaier BM. Determining eligibility for Allogeneic hematopoietic transplantation. In: Rosmarin AG, ed. UpToDate; 2022.



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ICD-10-CM Codes that Support Medical Necessity

Group 1

(372 Codes)
Group 1 Paragraph

Hospital Inpatient Claims:

  • The hospital should report the patient's principal diagnosis in Form Locator (FL) 67 of the UB-04. The principal diagnosis is the condition established after study to be chiefly responsible for this admission.
  • The hospital enters ICD-10-CM codes for up to 8 additional conditions in FLs 67A-67Q, if they co-existed at the time of admission or developed subsequently, and which had an effect upon the treatment or the length of stay. It may not duplicate the principal diagnosis listed in FL 67.
  • For inpatient hospital claims, the admitting diagnosis is required and should be recorded in FL 69. (See CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 25, §75 General Instructions for Completion of Form CMS-1450 for Billing for additional instructions.)

Hospital Outpatient Claims:

  • The hospital should report the full ICD-10-CM code for the diagnosis shown to be chiefly responsible for the outpatient services in FL 67. If no definitive diagnosis is made during the outpatient evaluation, the patient's symptom is reported. If the patient arrives without a referring diagnosis, symptom or complaint, the provider should report an ICD-10-CM code for Persons Without Reported Diagnosis Encountered During Examination and Investigation of Individuals and Populations (Z00.00-Z13.9).
  • The hospital enters the full ICD-10-CM codes in FLs 67A-67Q for up to 8 other diagnoses that co-existed in addition to the diagnosis reported in FL 67.

Group 1 Codes
Code Description
C81.00 Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site
C81.01 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.02 Nodular lymphocyte predominant Hodgkin lymphoma, intrathoracic lymph nodes
C81.03 Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes
C81.04 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.05 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.06 Nodular lymphocyte predominant Hodgkin lymphoma, intrapelvic lymph nodes
C81.07 Nodular lymphocyte predominant Hodgkin lymphoma, spleen
C81.08 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of multiple sites
C81.09 Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites
C81.10 Nodular sclerosis Hodgkin lymphoma, unspecified site
C81.11 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.12 Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes
C81.13 Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes
C81.14 Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.15 Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.16 Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes
C81.17 Nodular sclerosis Hodgkin lymphoma, spleen
C81.18 Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites
C81.19 Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites
C81.20 Mixed cellularity Hodgkin lymphoma, unspecified site
C81.21 Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.22 Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes
C81.23 Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes
C81.24 Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.25 Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.26 Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes
C81.27 Mixed cellularity Hodgkin lymphoma, spleen
C81.28 Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites
C81.29 Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites
C81.30 Lymphocyte depleted Hodgkin lymphoma, unspecified site
C81.31 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.32 Lymphocyte depleted Hodgkin lymphoma, intrathoracic lymph nodes
C81.33 Lymphocyte depleted Hodgkin lymphoma, intra-abdominal lymph nodes
C81.34 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.35 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.36 Lymphocyte depleted Hodgkin lymphoma, intrapelvic lymph nodes
C81.37 Lymphocyte depleted Hodgkin lymphoma, spleen
C81.38 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of multiple sites
C81.39 Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites
C81.40 Lymphocyte-rich Hodgkin lymphoma, unspecified site
C81.41 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.42 Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes
C81.43 Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes
C81.44 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.45 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.46 Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes
C81.47 Lymphocyte-rich Hodgkin lymphoma, spleen
C81.48 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites
C81.49 Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites
C81.70 Other Hodgkin lymphoma, unspecified site
C81.71 Other Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.72 Other Hodgkin lymphoma, intrathoracic lymph nodes
C81.73 Other Hodgkin lymphoma, intra-abdominal lymph nodes
C81.74 Other Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.75 Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.76 Other Hodgkin lymphoma, intrapelvic lymph nodes
C81.77 Other Hodgkin lymphoma, spleen
C81.78 Other Hodgkin lymphoma, lymph nodes of multiple sites
C81.79 Other Hodgkin lymphoma, extranodal and solid organ sites
C81.90 Hodgkin lymphoma, unspecified, unspecified site
C81.91 Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck
C81.92 Hodgkin lymphoma, unspecified, intrathoracic lymph nodes
C81.93 Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes
C81.94 Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb
C81.95 Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C81.96 Hodgkin lymphoma, unspecified, intrapelvic lymph nodes
C81.97 Hodgkin lymphoma, unspecified, spleen
C81.98 Hodgkin lymphoma, unspecified, lymph nodes of multiple sites
C81.99 Hodgkin lymphoma, unspecified, extranodal and solid organ sites
C82.00 Follicular lymphoma grade I, unspecified site
C82.01 Follicular lymphoma grade I, lymph nodes of head, face, and neck
C82.02 Follicular lymphoma grade I, intrathoracic lymph nodes
C82.03 Follicular lymphoma grade I, intra-abdominal lymph nodes
C82.04 Follicular lymphoma grade I, lymph nodes of axilla and upper limb
C82.05 Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb
C82.06 Follicular lymphoma grade I, intrapelvic lymph nodes
C82.07 Follicular lymphoma grade I, spleen
C82.08 Follicular lymphoma grade I, lymph nodes of multiple sites
C82.09 Follicular lymphoma grade I, extranodal and solid organ sites
C82.10 Follicular lymphoma grade II, unspecified site
C82.11 Follicular lymphoma grade II, lymph nodes of head, face, and neck
C82.12 Follicular lymphoma grade II, intrathoracic lymph nodes
C82.13 Follicular lymphoma grade II, intra-abdominal lymph nodes
C82.14 Follicular lymphoma grade II, lymph nodes of axilla and upper limb
C82.15 Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb
C82.16 Follicular lymphoma grade II, intrapelvic lymph nodes
C82.17 Follicular lymphoma grade II, spleen
C82.18 Follicular lymphoma grade II, lymph nodes of multiple sites
C82.19 Follicular lymphoma grade II, extranodal and solid organ sites
C82.20 Follicular lymphoma grade III, unspecified, unspecified site
C82.21 Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck
C82.22 Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes
C82.23 Follicular lymphoma grade III, unspecified, intra-abdominal lymph nodes
C82.24 Follicular lymphoma grade III, unspecified, lymph nodes of axilla and upper limb
C82.25 Follicular lymphoma grade III, unspecified, lymph nodes of inguinal region and lower limb
C82.26 Follicular lymphoma grade III, unspecified, intrapelvic lymph nodes
C82.27 Follicular lymphoma grade III, unspecified, spleen
C82.28 Follicular lymphoma grade III, unspecified, lymph nodes of multiple sites
C82.29 Follicular lymphoma grade III, unspecified, extranodal and solid organ sites
C82.30 Follicular lymphoma grade IIIa, unspecified site
C82.31 Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck
C82.32 Follicular lymphoma grade IIIa, intrathoracic lymph nodes
C82.33 Follicular lymphoma grade IIIa, intra-abdominal lymph nodes
C82.34 Follicular lymphoma grade IIIa, lymph nodes of axilla and upper limb
C82.35 Follicular lymphoma grade IIIa, lymph nodes of inguinal region and lower limb
C82.36 Follicular lymphoma grade IIIa, intrapelvic lymph nodes
C82.37 Follicular lymphoma grade IIIa, spleen
C82.38 Follicular lymphoma grade IIIa, lymph nodes of multiple sites
C82.39 Follicular lymphoma grade IIIa, extranodal and solid organ sites
C82.40 Follicular lymphoma grade IIIb, unspecified site
C82.41 Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck
C82.42 Follicular lymphoma grade IIIb, intrathoracic lymph nodes
C82.43 Follicular lymphoma grade IIIb, intra-abdominal lymph nodes
C82.44 Follicular lymphoma grade IIIb, lymph nodes of axilla and upper limb
C82.45 Follicular lymphoma grade IIIb, lymph nodes of inguinal region and lower limb
C82.46 Follicular lymphoma grade IIIb, intrapelvic lymph nodes
C82.47 Follicular lymphoma grade IIIb, spleen
C82.48 Follicular lymphoma grade IIIb, lymph nodes of multiple sites
C82.49 Follicular lymphoma grade IIIb, extranodal and solid organ sites
C82.50 Diffuse follicle center lymphoma, unspecified site
C82.51 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck
C82.52 Diffuse follicle center lymphoma, intrathoracic lymph nodes
C82.53 Diffuse follicle center lymphoma, intra-abdominal lymph nodes
C82.54 Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb
C82.55 Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.56 Diffuse follicle center lymphoma, intrapelvic lymph nodes
C82.57 Diffuse follicle center lymphoma, spleen
C82.58 Diffuse follicle center lymphoma, lymph nodes of multiple sites
C82.59 Diffuse follicle center lymphoma, extranodal and solid organ sites
C82.60 Cutaneous follicle center lymphoma, unspecified site
C82.61 Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck
C82.62 Cutaneous follicle center lymphoma, intrathoracic lymph nodes
C82.63 Cutaneous follicle center lymphoma, intra-abdominal lymph nodes
C82.64 Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb
C82.65 Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.66 Cutaneous follicle center lymphoma, intrapelvic lymph nodes
C82.67 Cutaneous follicle center lymphoma, spleen
C82.68 Cutaneous follicle center lymphoma, lymph nodes of multiple sites
C82.69 Cutaneous follicle center lymphoma, extranodal and solid organ sites
C82.80 Other types of follicular lymphoma, unspecified site
C82.81 Other types of follicular lymphoma, lymph nodes of head, face, and neck
C82.82 Other types of follicular lymphoma, intrathoracic lymph nodes
C82.83 Other types of follicular lymphoma, intra-abdominal lymph nodes
C82.84 Other types of follicular lymphoma, lymph nodes of axilla and upper limb
C82.85 Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb
C82.86 Other types of follicular lymphoma, intrapelvic lymph nodes
C82.87 Other types of follicular lymphoma, spleen
C82.88 Other types of follicular lymphoma, lymph nodes of multiple sites
C82.89 Other types of follicular lymphoma, extranodal and solid organ sites
C82.90 Follicular lymphoma, unspecified, unspecified site
C82.91 Follicular lymphoma, unspecified, lymph nodes of head, face, and neck
C82.92 Follicular lymphoma, unspecified, intrathoracic lymph nodes
C82.93 Follicular lymphoma, unspecified, intra-abdominal lymph nodes
C82.94 Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb
C82.95 Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C82.96 Follicular lymphoma, unspecified, intrapelvic lymph nodes
C82.97 Follicular lymphoma, unspecified, spleen
C82.98 Follicular lymphoma, unspecified, lymph nodes of multiple sites
C82.99 Follicular lymphoma, unspecified, extranodal and solid organ sites
C83.00 Small cell B-cell lymphoma, unspecified site
C83.01 Small cell B-cell lymphoma, lymph nodes of head, face, and neck
C83.02 Small cell B-cell lymphoma, intrathoracic lymph nodes
C83.03 Small cell B-cell lymphoma, intra-abdominal lymph nodes
C83.04 Small cell B-cell lymphoma, lymph nodes of axilla and upper limb
C83.05 Small cell B-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.06 Small cell B-cell lymphoma, intrapelvic lymph nodes
C83.07 Small cell B-cell lymphoma, spleen
C83.08 Small cell B-cell lymphoma, lymph nodes of multiple sites
C83.09 Small cell B-cell lymphoma, extranodal and solid organ sites
C83.10 Mantle cell lymphoma, unspecified site
C83.11 Mantle cell lymphoma, lymph nodes of head, face, and neck
C83.12 Mantle cell lymphoma, intrathoracic lymph nodes
C83.13 Mantle cell lymphoma, intra-abdominal lymph nodes
C83.14 Mantle cell lymphoma, lymph nodes of axilla and upper limb
C83.15 Mantle cell lymphoma, lymph nodes of inguinal region and lower limb
C83.16 Mantle cell lymphoma, intrapelvic lymph nodes
C83.17 Mantle cell lymphoma, spleen
C83.18 Mantle cell lymphoma, lymph nodes of multiple sites
C83.19 Mantle cell lymphoma, extranodal and solid organ sites
C83.30 Diffuse large B-cell lymphoma, unspecified site
C83.31 Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck
C83.32 Diffuse large B-cell lymphoma, intrathoracic lymph nodes
C83.33 Diffuse large B-cell lymphoma, intra-abdominal lymph nodes
C83.34 Diffuse large B-cell lymphoma, lymph nodes of axilla and upper limb
C83.35 Diffuse large B-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.36 Diffuse large B-cell lymphoma, intrapelvic lymph nodes
C83.37 Diffuse large B-cell lymphoma, spleen
C83.38 Diffuse large B-cell lymphoma, lymph nodes of multiple sites
C83.50 Lymphoblastic (diffuse) lymphoma, unspecified site
C83.51 Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck
C83.52 Lymphoblastic (diffuse) lymphoma, intrathoracic lymph nodes
C83.53 Lymphoblastic (diffuse) lymphoma, intra-abdominal lymph nodes
C83.54 Lymphoblastic (diffuse) lymphoma, lymph nodes of axilla and upper limb
C83.55 Lymphoblastic (diffuse) lymphoma, lymph nodes of inguinal region and lower limb
C83.56 Lymphoblastic (diffuse) lymphoma, intrapelvic lymph nodes
C83.57 Lymphoblastic (diffuse) lymphoma, spleen
C83.58 Lymphoblastic (diffuse) lymphoma, lymph nodes of multiple sites
C83.59 Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites
C83.70 Burkitt lymphoma, unspecified site
C83.71 Burkitt lymphoma, lymph nodes of head, face, and neck
C83.72 Burkitt lymphoma, intrathoracic lymph nodes
C83.73 Burkitt lymphoma, intra-abdominal lymph nodes
C83.74 Burkitt lymphoma, lymph nodes of axilla and upper limb
C83.75 Burkitt lymphoma, lymph nodes of inguinal region and lower limb
C83.76 Burkitt lymphoma, intrapelvic lymph nodes
C83.77 Burkitt lymphoma, spleen
C83.78 Burkitt lymphoma, lymph nodes of multiple sites
C83.79 Burkitt lymphoma, extranodal and solid organ sites
C83.80 Other non-follicular lymphoma, unspecified site
C83.81 Other non-follicular lymphoma, lymph nodes of head, face, and neck
C83.82 Other non-follicular lymphoma, intrathoracic lymph nodes
C83.83 Other non-follicular lymphoma, intra-abdominal lymph nodes
C83.84 Other non-follicular lymphoma, lymph nodes of axilla and upper limb
C83.85 Other non-follicular lymphoma, lymph nodes of inguinal region and lower limb
C83.86 Other non-follicular lymphoma, intrapelvic lymph nodes
C83.87 Other non-follicular lymphoma, spleen
C83.88 Other non-follicular lymphoma, lymph nodes of multiple sites
C83.89 Other non-follicular lymphoma, extranodal and solid organ sites
C83.90 Non-follicular (diffuse) lymphoma, unspecified, unspecified site
C83.91 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck
C83.92 Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes
C83.93 Non-follicular (diffuse) lymphoma, unspecified, intra-abdominal lymph nodes
C83.94 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of axilla and upper limb
C83.95 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C83.96 Non-follicular (diffuse) lymphoma, unspecified, intrapelvic lymph nodes
C83.97 Non-follicular (diffuse) lymphoma, unspecified, spleen
C83.98 Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of multiple sites
C83.99 Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites
C84.00 Mycosis fungoides, unspecified site
C84.01 Mycosis fungoides, lymph nodes of head, face, and neck
C84.02 Mycosis fungoides, intrathoracic lymph nodes
C84.03 Mycosis fungoides, intra-abdominal lymph nodes
C84.04 Mycosis fungoides, lymph nodes of axilla and upper limb
C84.05 Mycosis fungoides, lymph nodes of inguinal region and lower limb
C84.06 Mycosis fungoides, intrapelvic lymph nodes
C84.07 Mycosis fungoides, spleen
C84.08 Mycosis fungoides, lymph nodes of multiple sites
C84.09 Mycosis fungoides, extranodal and solid organ sites
C84.10 Sezary disease, unspecified site
C84.11 Sezary disease, lymph nodes of head, face, and neck
C84.12 Sezary disease, intrathoracic lymph nodes
C84.13 Sezary disease, intra-abdominal lymph nodes
C84.14 Sezary disease, lymph nodes of axilla and upper limb
C84.15 Sezary disease, lymph nodes of inguinal region and lower limb
C84.16 Sezary disease, intrapelvic lymph nodes
C84.17 Sezary disease, spleen
C84.18 Sezary disease, lymph nodes of multiple sites
C84.19 Sezary disease, extranodal and solid organ sites
C84.40 Peripheral T-cell lymphoma, not elsewhere classified, unspecified site
C84.41 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of head, face, and neck
C84.42 Peripheral T-cell lymphoma, not elsewhere classified, intrathoracic lymph nodes
C84.43 Peripheral T-cell lymphoma, not elsewhere classified, intra-abdominal lymph nodes
C84.44 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of axilla and upper limb
C84.45 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of inguinal region and lower limb
C84.46 Peripheral T-cell lymphoma, not elsewhere classified, intrapelvic lymph nodes
C84.47 Peripheral T-cell lymphoma, not elsewhere classified, spleen
C84.48 Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of multiple sites
C84.49 Peripheral T-cell lymphoma, not elsewhere classified, extranodal and solid organ sites
C84.60 Anaplastic large cell lymphoma, ALK-positive, unspecified site
C84.61 Anaplastic large cell lymphoma, ALK-positive, lymph nodes of head, face, and neck
C84.62 Anaplastic large cell lymphoma, ALK-positive, intrathoracic lymph nodes
C84.63 Anaplastic large cell lymphoma, ALK-positive, intra-abdominal lymph nodes
C84.64 Anaplastic large cell lymphoma, ALK-positive, lymph nodes of axilla and upper limb
C84.65 Anaplastic large cell lymphoma, ALK-positive, lymph nodes of inguinal region and lower limb
C84.66 Anaplastic large cell lymphoma, ALK-positive, intrapelvic lymph nodes
C84.67 Anaplastic large cell lymphoma, ALK-positive, spleen
C84.68 Anaplastic large cell lymphoma, ALK-positive, lymph nodes of multiple sites
C84.69 Anaplastic large cell lymphoma, ALK-positive, extranodal and solid organ sites
C84.70 Anaplastic large cell lymphoma, ALK-negative, unspecified site
C84.71 Anaplastic large cell lymphoma, ALK-negative, lymph nodes of head, face, and neck
C84.72 Anaplastic large cell lymphoma, ALK-negative, intrathoracic lymph nodes
C84.73 Anaplastic large cell lymphoma, ALK-negative, intra-abdominal lymph nodes
C84.74 Anaplastic large cell lymphoma, ALK-negative, lymph nodes of axilla and upper limb
C84.75 Anaplastic large cell lymphoma, ALK-negative, lymph nodes of inguinal region and lower limb
C84.76 Anaplastic large cell lymphoma, ALK-negative, intrapelvic lymph nodes
C84.77 Anaplastic large cell lymphoma, ALK-negative, spleen
C84.78 Anaplastic large cell lymphoma, ALK-negative, lymph nodes of multiple sites
C84.79 Anaplastic large cell lymphoma, ALK-negative, extranodal and solid organ sites
C84.7A Anaplastic large cell lymphoma, ALK-negative, breast
C84.A0 Cutaneous T-cell lymphoma, unspecified, unspecified site
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.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.Z0 Other mature T/NK-cell lymphomas, unspecified site
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
C84.90 Mature T/NK-cell lymphomas, unspecified, unspecified site
C84.91 Mature T/NK-cell lymphomas, unspecified, lymph nodes of head, face, and neck
C84.92 Mature T/NK-cell lymphomas, unspecified, intrathoracic lymph nodes
C84.93 Mature T/NK-cell lymphomas, unspecified, intra-abdominal lymph nodes
C84.94 Mature T/NK-cell lymphomas, unspecified, lymph nodes of axilla and upper limb
C84.95 Mature T/NK-cell lymphomas, unspecified, lymph nodes of inguinal region and lower limb
C84.96 Mature T/NK-cell lymphomas, unspecified, intrapelvic lymph nodes
C84.97 Mature T/NK-cell lymphomas, unspecified, spleen
C84.98 Mature T/NK-cell lymphomas, unspecified, lymph nodes of multiple sites
C84.99 Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
C85.10 Unspecified B-cell lymphoma, unspecified site
C85.11 Unspecified B-cell lymphoma, lymph nodes of head, face, and neck
C85.12 Unspecified B-cell lymphoma, intrathoracic lymph nodes
C85.13 Unspecified B-cell lymphoma, intra-abdominal lymph nodes
C85.14 Unspecified B-cell lymphoma, lymph nodes of axilla and upper limb
C85.15 Unspecified B-cell lymphoma, lymph nodes of inguinal region and lower limb
C85.16 Unspecified B-cell lymphoma, intrapelvic lymph nodes
C85.17 Unspecified B-cell lymphoma, spleen
C85.18 Unspecified B-cell lymphoma, lymph nodes of multiple sites
C85.19 Unspecified B-cell lymphoma, extranodal and solid organ sites
C85.20 Mediastinal (thymic) large B-cell lymphoma, unspecified site
C85.21 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck
C85.22 Mediastinal (thymic) large B-cell lymphoma, intrathoracic lymph nodes
C85.23 Mediastinal (thymic) large B-cell lymphoma, intra-abdominal lymph nodes
C85.24 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of axilla and upper limb
C85.25 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of inguinal region and lower limb
C85.26 Mediastinal (thymic) large B-cell lymphoma, intrapelvic lymph nodes
C85.27 Mediastinal (thymic) large B-cell lymphoma, spleen
C85.28 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of multiple sites
C85.29 Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites
C85.80 Other specified types of non-Hodgkin lymphoma, unspecified site
C85.81 Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck
C85.82 Other specified types of non-Hodgkin lymphoma, intrathoracic lymph nodes
C85.83 Other specified types of non-Hodgkin lymphoma, intra-abdominal lymph nodes
C85.84 Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb
C85.85 Other specified types of non-Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C85.86 Other specified types of non-Hodgkin lymphoma, intrapelvic lymph nodes
C85.87 Other specified types of non-Hodgkin lymphoma, spleen
C85.88 Other specified types of non-Hodgkin lymphoma, lymph nodes of multiple sites
C85.89 Other specified types of non-Hodgkin lymphoma, extranodal and solid organ sites
C85.90 Non-Hodgkin lymphoma, unspecified, unspecified site
C85.91 Non-Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck
C85.92 Non-Hodgkin lymphoma, unspecified, intrathoracic lymph nodes
C85.93 Non-Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes
C85.94 Non-Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb
C85.95 Non-Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C85.96 Non-Hodgkin lymphoma, unspecified, intrapelvic lymph nodes
C85.97 Non-Hodgkin lymphoma, unspecified, spleen
C85.98 Non-Hodgkin lymphoma, unspecified, lymph nodes of multiple sites
C85.99 Non-Hodgkin lymphoma, unspecified, extranodal and solid organ sites
C86.10 Hepatosplenic T-cell lymphoma not having achieved remission
C86.11 Hepatosplenic T-cell lymphoma, in remission
C86.20 Enteropathy-type (intestinal) T-cell lymphoma not having achieved remission
C86.21 Enteropathy-type (intestinal) T-cell lymphoma, in remission
C86.30 Subcutaneous panniculitis-like T-cell lymphoma not having achieved remission
C86.31 Subcutaneous panniculitis-like T-cell lymphoma, in remission
C86.40 Blastic NK-cell lymphoma not having achieved remission
C86.41 Blastic NK-cell lymphoma, in remission
C86.50 Angioimmunoblastic T-cell lymphoma not having achieved remission
C86.51 Angioimmunoblastic T-cell lymphoma, in remission
C86.60 Primary cutaneous CD30-positive T-cell proliferations not having achieved remission
C88.00 Waldenstrom macroglobulinemia not having achieved remission
C88.01 Waldenstrom macroglobulinemia, in remission
C88.20 Heavy chain disease not having achieved remission
C88.21 Heavy chain disease, in remission
C88.30 Immunoproliferative small intestinal disease not having achieved remission
C88.31 Immunoproliferative small intestinal disease, in remission
C88.40 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma] not having achieved remission
C88.41 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma], in remission
C88.80 Other malignant immunoproliferative diseases not having achieved remission
C88.81 Other malignant immunoproliferative diseases, in remission
C88.90 Malignant immunoproliferative disease, unspecified not having achieved remission
C88.91 Malignant immunoproliferative disease, unspecified, in remission
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

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ICD-10-PCS Codes

Group 1

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Group 1 Codes

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Additional ICD-10 Information

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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.

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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.

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Other Coding Information

Group 1

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Group 1 Codes

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

Revision History Date Revision History Number Revision History Explanation
10/01/2024 R3

Revision Effective: 10/01/2024

Revision Explanation Codes C83.39, C86.0-C86.6, C88.0, C88.2-C88.4, C88.8, and C88.9 were deleted during the ICD-10 annual review in group 1 and the following codes were added:

C86.10
C86.11
C86.20
C86.21
C86.30
C86.31
C86.40
C86.41
C86.50
C86.51
C86.60
C88.00
C88.01
C88.20
C88.21
C88.30
C88.31
C88.40
C88.41
C88.80
C88.81
C88.90
C88.91

03/07/2024 R2

Revision Effective: 03/07/2024

Revision Explanation: Annual review, no changes.

11/16/2023 R1

Revision Effective: 11/16/2023

Revision Explanation: Updated LCD Reference Article section.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Public Versions
Updated On Effective Dates Status
09/09/2024 10/01/2024 - N/A Currently in Effect You are here
02/29/2024 03/07/2024 - 09/30/2024 Superseded View
11/07/2023 11/16/2023 - 03/06/2024 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • allogeneic
  • stem cells
  • Hodgkin's lymphoma
  • non-Hodgkin's lymphoma
  • hematopoietic cell transplantation