D42.0: Neoplasm of uncertain behavior of cerebral meninges

Risk adjustment

D42.0 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 23 Prostate, Breast, and Other Cancers and Tumors0.186 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

D42.0 is named in 31 Medicare coverage policies: 31 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
• A55315Billing and Coding: Proton Beam Therapy
• A56462Billing and Coding: Erythropoiesis Stimulating Agents (ESA)