C85.94: Non-Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb

Risk adjustment

C85.94 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 21 Lymphoma and Other Cancers0.671 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

C85.94 is named in 52 Medicare coverage policies: 52 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
• A52479Oral Anticancer Drugs - Policy Article
• A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
• A54768Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy