C95.12 — Chronic leukemia of unspecified cell type, in relapse

Risk adjustment

C95.12 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

C95.12 is named in 40 Medicare coverage policies — 38 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
• 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