C68.1: Malignant neoplasm of paraurethral glands

Risk adjustment

C68.1 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

C68.1 is named in 55 Medicare coverage policies: 55 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52479Oral Anticancer Drugs - Policy Article
• A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
• A52986Billing and Coding: Biomarkers for Oncology
• A54768Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy