C50.412 — Malignant neoplasm of upper-outer quadrant of left female breast

Risk adjustment

C50.412 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:

• HCC 22 Bladder, Colorectal, and Other Cancers0.363 RAF
• HCC 23 Prostate, Breast, and Other Cancers and Tumors0.186 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.

Medicare coverage

C50.412 is named in 152 Medicare coverage policies — 152 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• A52370Billing and Coding: Bevacizumab and biosimilars
• A52399Billing and Coding: Denosumab (Prolia®, Xgeva®, Jubbonti®, Wyost®, Ospomyv™,Xbryk™,Bomyntra®, Conexxence®, Stoboclo®, Osenvelt®,Bildyos®, Bilprevda®)
• A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
• A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)