C65.9: Malignant neoplasm of unspecified renal pelvis

Risk adjustment

C65.9 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

C65.9 is named in 40 Medicare coverage policies: 40 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