Is D49.4 a billable ICD-10-CM code?

Yes. D49.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does D49.4 sit in the tabular list?

Neoplasms (C00-D49), in the block Neoplasms of unspecified behavior (D49).

D49.4

D49.4 — Neoplasm of unspecified behavior of bladder

Billable / specific codeICD-10-CM

D49.4 is a billable, specific ICD-10-CM code for neoplasm of unspecified behavior of bladder. It is valid for submission on a claim.

Excludes2 inherited from the categories above D49.4

Also inherited, and the opposite of Excludes1: these conditions are not part of D49.4, but a patient can have both, so you may code both.

Written on D49 — Neoplasms of unspecified behavior

neoplasms of uncertain behavior (D37-D44, D48)

Risk adjustment

D49.4 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

D49.4 is named in 23 Medicare coverage policies — 23 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52986Billing and Coding: Biomarkers for Oncology
A53095Billing and Coding: Lab: Bladder/Urothelial Tumor Markers
A53101Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® Update
A54188Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®

Code history

D49.4 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share D49. If D49.4 is not quite right, the correct code is usually one of these.

Questions about D49.4

Is D49.4 a billable ICD-10-CM code?: Yes. D49.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does D49.4 sit in the tabular list?: Neoplasms (C00-D49), in the block Neoplasms of unspecified behavior (D49).