C72.1: Malignant neoplasm of cauda equina

Risk adjustment

C72.1 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

C72.1 is named in 71 Medicare coverage policies: 71 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52370Billing and Coding: Bevacizumab and biosimilars
• A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
• A54095Billing and Coding: Nerve Conduction Studies and Electromyography
• A54768Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy