C04.9: Malignant neoplasm of floor of mouth, unspecified

Risk adjustment

C04.9 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 21 Lymphoma and Other Cancers0.671 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

C04.9 is named in 44 Medicare coverage policies: 44 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
• A52479Oral Anticancer Drugs - Policy Article
• A54768Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy
• A55315Billing and Coding: Proton Beam Therapy