Is D43.1 a billable ICD-10-CM code?

Yes. D43.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does D43.1 sit in the tabular list?

Neoplasms (C00-D49), in the block Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48).

D43.1

D43.1 — Neoplasm of uncertain behavior of brain, infratentorial

Billable / specific codeICD-10-CM

D43.1 is a billable, specific ICD-10-CM code for neoplasm of uncertain behavior of brain, infratentorial. It is valid for submission on a claim.

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Neoplasm of uncertain behavior of brain stem
Neoplasm of uncertain behavior of cerebellum
Neoplasm of uncertain behavior of fourth ventricle

Other codes that can never be billed with D43.1

These codes carry an Excludes1 note pointing at D43.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading D43.1 alone.

D43.0Neoplasm of uncertain behavior of brain, supratentorial

Risk adjustment

D43.1 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.

Medicare coverage

D43.1 is named in 39 Medicare coverage policies — 39 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

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Related codes at this level

Codes that share D43. If D43.1 is not quite right, the correct code is usually one of these.

Questions about D43.1

Is D43.1 a billable ICD-10-CM code?: Yes. D43.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does D43.1 sit in the tabular list?: Neoplasms (C00-D49), in the block Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes (D37-D48).