C92.42 — Acute promyelocytic leukemia, in relapse

Risk adjustment

C92.42 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.

Medicare coverage

C92.42 is named in 79 Medicare coverage policies — 77 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• A56462Billing and Coding: Erythropoiesis Stimulating Agents (ESA)not covered
• A60435Billing and Coding: Erythropoiesis Stimulating Agents (ESA)not covered
• A52479Oral Anticancer Drugs - Policy Article
• A52479Oral Anticancer Drugs - Policy Article