D49.6

D49.6: Neoplasm of unspecified behavior of brain

Billable / specific codeICD-10-CM

D49.6 is a billable, specific ICD-10-CM code for neoplasm of unspecified behavior of brain. It is valid for submission on a claim.

Check D49.6 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

neoplasm of unspecified behavior of cerebral meninges (D49.7)
neoplasm of unspecified behavior of cranial nerves (D49.7)

Excludes2 inherited from the categories above D49.6

Not part of this code, but both may be coded when both are present.

Written on D49: Neoplasms of unspecified behavior

neoplasms of uncertain behavior (D37-D44, D48)

Risk adjustment

D49.6 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

D49.6 is named in 28 Medicare coverage policies: 28 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
A52986Billing and Coding: Biomarkers for Oncology
A53101Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® Update
A54188Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®

Alphabetic index entries that lead here

Degeneration, degenerative›brain›in›neoplastic disease

Code history

Unchanged in every release from FY2024 to FY2027.