C65.1
C65.1: Malignant neoplasm of right renal pelvis
Billable / specific codeICD-10-CMright
C65.1 is a billable, specific ICD-10-CM code for malignant neoplasm of right renal pelvis. It is valid for submission on a claim.
Check C65.1 with the rest of the claim: free scrubberOther codes that can never be billed with C65.1
Their own Excludes1 notes name this code, so the conflict is not listed above.
- C64Malignant neoplasm of kidney, except renal pelvis
Risk adjustment
C65.1 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 22 Bladder, Colorectal, and Other Cancers0.363 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
C65.1 is named in 66 Medicare coverage policies: 66 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52370Billing and Coding: Bevacizumab and biosimilars
- A52399Billing and Coding: Denosumab (Prolia®, Xgeva®, Jubbonti®) and biosimilars
- A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
- A52479Oral Anticancer Drugs - Policy Article
Code history
Unchanged in every release from FY2024 to FY2027.