C48.1

C48.1: Malignant neoplasm of specified parts of peritoneum

Billable / specific codeICD-10-CM

C48.1 is a billable, specific ICD-10-CM code for malignant neoplasm of specified parts of peritoneum. It is valid for submission on a claim.

Check C48.1 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Malignant neoplasm of cul-de-sac
Malignant neoplasm of mesentery
Malignant neoplasm of mesocolon
Malignant neoplasm of omentum
Malignant neoplasm of parietal peritoneum
Malignant neoplasm of pelvic peritoneum

Excludes1 inherited from the categories above C48.1

A category’s note binds every code beneath it.

Written on C48: Malignant neoplasm of retroperitoneum and peritoneum

Kaposi's sarcoma of connective tissue (C46.1)
mesothelioma (C45.-)

Other codes that can never be billed with C48.1

Their own Excludes1 notes name this code, so the conflict is not listed above.

C26Malignant neoplasm of other and ill-defined digestive organs
C45.1Mesothelioma of peritoneum

Risk adjustment

C48.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 20 Lung and Other Severe Cancers1.136 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

C48.1 is named in 68 Medicare coverage policies: 68 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52370Billing and Coding: Bevacizumab and biosimilars
A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
A52453Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
A52479Oral Anticancer Drugs - Policy Article

Code history

Unchanged in every release from FY2024 to FY2027.