Automated World Health
L29254
PEGFILGRASTIM (NEULASTA TM)
10/01/2010
Indications and Limitations of Coverage and/or Medical Necessity
• The recommended dosage of pegfilgrastim is 6 mg administered once per chemotherapy cycle.
• The administration should NOT occur:
o Within 14 days before.
And
o 24 hours after, administration of cytotoxic chemotherapy.
• Medicare will allow the following OFF-LABEL exception to this rule as follows:
o If the patient is on a dose dense 14 day chemotherapy cycle, it would be acceptable to administer Neulasta:
Outside of the 14 day before and 24 hour after rule for chemotherapy.
• Neulasta would typically be administered on the second day of the 14-day dose dense chemotherapy cycle.
o An example of this would be a patient receiving dose dense cytoxan/adriamycin and taxol for breast cancer.
o The chemotherapy drug record/orders should indicate that the patient is on a 14-day dose dense chemotherapy schedule.
CPT/HCPCS Codes
J2505 INJECTION, PEGFILGRASTIM, 6 MG
ICD-9 Codes that Support Medical Necessity
140.0 MALIGNANT NEOPLASM OF UPPER LIP VERMILION BORDER
140.1 MALIGNANT NEOPLASM OF LOWER LIP VERMILION BORDER
140.3 MALIGNANT NEOPLASM OF UPPER LIP INNER ASPECT
140.4 MALIGNANT NEOPLASM OF LOWER LIP INNER ASPECT
140.5 MALIGNANT NEOPLASM OF LIP UNSPECIFIED INNER ASPECT
140.6 MALIGNANT NEOPLASM OF COMMISSURE OF LIP
140.8 MALIGNANT NEOPLASM OF OTHER SITES OF LIP
140.9 MALIGNANT NEOPLASM OF LIP UNSPECIFIED VERMILION BORDER
141.0 MALIGNANT NEOPLASM OF BASE OF TONGUE
141.1 MALIGNANT NEOPLASM OF DORSAL SURFACE OF TONGUE
141.2 MALIGNANT NEOPLASM OF TIP AND LATERAL BORDER OF TONGUE
141.3 MALIGNANT NEOPLASM OF VENTRAL SURFACE OF TONGUE
141.4 MALIGNANT NEOPLASM OF ANTERIOR TWO-THIRDS OF TONGUE PART UNSPECIFIED
141.5 MALIGNANT NEOPLASM OF JUNCTIONAL ZONE OF TONGUE
141.6 MALIGNANT NEOPLASM OF LINGUAL TONSIL
141.8 MALIGNANT NEOPLASM OF OTHER SITES OF TONGUE
141.9 MALIGNANT NEOPLASM OF TONGUE UNSPECIFIED
142.0 MALIGNANT NEOPLASM OF PAROTID GLAND
142.1 MALIGNANT NEOPLASM OF SUBMANDIBULAR GLAND
142.2 MALIGNANT NEOPLASM OF SUBLINGUAL GLAND
142.8 MALIGNANT NEOPLASM OF OTHER MAJOR SALIVARY GLANDS
142.9 MALIGNANT NEOPLASM OF SALIVARY GLAND UNSPECIFIED
143.0 MALIGNANT NEOPLASM OF UPPER GUM
143.1 MALIGNANT NEOPLASM OF LOWER GUM
143.8 MALIGNANT NEOPLASM OF OTHER SITES OF GUM
143.9 MALIGNANT NEOPLASM OF GUM UNSPECIFIED
144.0 MALIGNANT NEOPLASM OF ANTERIOR PORTION OF FLOOR OF MOUTH
144.1 MALIGNANT NEOPLASM OF LATERAL PORTION OF FLOOR OF MOUTH
144.8 MALIGNANT NEOPLASM OF OTHER SITES OF FLOOR OF MOUTH
144.9 MALIGNANT NEOPLASM OF FLOOR OF MOUTH PART UNSPECIFIED
145.0 MALIGNANT NEOPLASM OF CHEEK MUCOSA
145.1 MALIGNANT NEOPLASM OF VESTIBULE OF MOUTH
145.2 MALIGNANT NEOPLASM OF HARD PALATE
145.3 MALIGNANT NEOPLASM OF SOFT PALATE
145.4 MALIGNANT NEOPLASM OF UVULA
145.5 MALIGNANT NEOPLASM OF PALATE UNSPECIFIED
145.6 MALIGNANT NEOPLASM OF RETROMOLAR AREA
145.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED PARTS OF MOUTH
145.9 MALIGNANT NEOPLASM OF MOUTH UNSPECIFIED
146.0 MALIGNANT NEOPLASM OF TONSIL
146.1 MALIGNANT NEOPLASM OF TONSILLAR FOSSA
146.2 MALIGNANT NEOPLASM OF TONSILLAR PILLARS (ANTERIOR) (POSTERIOR)
146.3 MALIGNANT NEOPLASM OF VALLECULA EPIGLOTTICA
146.4 MALIGNANT NEOPLASM OF ANTERIOR ASPECT OF EPIGLOTTIS
146.5 MALIGNANT NEOPLASM OF JUNCTIONAL REGION OF OROPHARYNX
146.6 MALIGNANT NEOPLASM OF LATERAL WALL OF OROPHARYNX
146.7 MALIGNANT NEOPLASM OF POSTERIOR WALL OF OROPHARYNX
146.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF OROPHARYNX
146.9 MALIGNANT NEOPLASM OF OROPHARYNX UNSPECIFIED SITE
147.0 MALIGNANT NEOPLASM OF SUPERIOR WALL OF NASOPHARYNX
147.1 MALIGNANT NEOPLASM OF POSTERIOR WALL OF NASOPHARYNX
147.2 MALIGNANT NEOPLASM OF LATERAL WALL OF NASOPHARYNX
147.3 MALIGNANT NEOPLASM OF ANTERIOR WALL OF NASOPHARYNX
147.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF NASOPHARYNX
147.9 MALIGNANT NEOPLASM OF NASOPHARYNX UNSPECIFIED SITE
148.0 MALIGNANT NEOPLASM OF POSTCRICOID REGION OF HYPOPHARYNX
148.1 MALIGNANT NEOPLASM OF PYRIFORM SINUS
148.2 MALIGNANT NEOPLASM OF ARYEPIGLOTTIC FOLD HYPOPHARYNGEAL ASPECT
148.3 MALIGNANT NEOPLASM OF POSTERIOR HYPOPHARYNGEAL WALL
148.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF HYPOPHARYNX
148.9 MALIGNANT NEOPLASM OF HYPOPHARYNX UNSPECIFIED SITE
149.0 MALIGNANT NEOPLASM OF PHARYNX UNSPECIFIED
149.1 MALIGNANT NEOPLASM OF WALDEYER'S RING
149.8 MALIGNANT NEOPLASM OF OTHER SITES WITHIN THE LIP AND ORAL CAVITY
149.9 MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE LIP AND ORAL CAVITY
150.0 MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS
150.1 MALIGNANT NEOPLASM OF THORACIC ESOPHAGUS
150.2 MALIGNANT NEOPLASM OF ABDOMINAL ESOPHAGUS
150.3 MALIGNANT NEOPLASM OF UPPER THIRD OF ESOPHAGUS
150.4 MALIGNANT NEOPLASM OF MIDDLE THIRD OF ESOPHAGUS
150.5 MALIGNANT NEOPLASM OF LOWER THIRD OF ESOPHAGUS
150.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED PART OF ESOPHAGUS
150.9 MALIGNANT NEOPLASM OF ESOPHAGUS UNSPECIFIED SITE
151.0 MALIGNANT NEOPLASM OF CARDIA
151.1 MALIGNANT NEOPLASM OF PYLORUS
151.2 MALIGNANT NEOPLASM OF PYLORIC ANTRUM
151.3 MALIGNANT NEOPLASM OF FUNDUS OF STOMACH
151.4 MALIGNANT NEOPLASM OF BODY OF STOMACH
151.5 MALIGNANT NEOPLASM OF LESSER CURVATURE OF STOMACH UNSPECIFIED
151.6 MALIGNANT NEOPLASM OF GREATER CURVATURE OF STOMACH UNSPECIFIED
151.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF STOMACH
151.9 MALIGNANT NEOPLASM OF STOMACH UNSPECIFIED SITE
152.0 MALIGNANT NEOPLASM OF DUODENUM
152.1 MALIGNANT NEOPLASM OF JEJUNUM
152.2 MALIGNANT NEOPLASM OF ILEUM
152.3 MALIGNANT NEOPLASM OF MECKEL'S DIVERTICULUM
152.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF SMALL INTESTINE
152.9 MALIGNANT NEOPLASM OF SMALL INTESTINE UNSPECIFIED SITE
153.0 MALIGNANT NEOPLASM OF HEPATIC FLEXURE
153.1 MALIGNANT NEOPLASM OF TRANSVERSE COLON
153.2 MALIGNANT NEOPLASM OF DESCENDING COLON
153.3 MALIGNANT NEOPLASM OF SIGMOID COLON
153.4 MALIGNANT NEOPLASM OF CECUM
153.5 MALIGNANT NEOPLASM OF APPENDIX VERMIFORMIS
153.6 MALIGNANT NEOPLASM OF ASCENDING COLON
153.7 MALIGNANT NEOPLASM OF SPLENIC FLEXURE
153.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF LARGE INTESTINE
153.9 MALIGNANT NEOPLASM OF COLON UNSPECIFIED SITE
154.0 MALIGNANT NEOPLASM OF RECTOSIGMOID JUNCTION
154.1 MALIGNANT NEOPLASM OF RECTUM
154.2 MALIGNANT NEOPLASM OF ANAL CANAL
154.3 MALIGNANT NEOPLASM OF ANUS UNSPECIFIED SITE
154.8 MALIGNANT NEOPLASM OF OTHER SITES OF RECTUM RECTOSIGMOID JUNCTION AND ANUS
155.0 MALIGNANT NEOPLASM OF LIVER PRIMARY
155.1 MALIGNANT NEOPLASM OF INTRAHEPATIC BILE DUCTS
155.2 MALIGNANT NEOPLASM OF LIVER NOT SPECIFIED AS PRIMARY OR SECONDARY
156.0 MALIGNANT NEOPLASM OF GALLBLADDER
156.1 MALIGNANT NEOPLASM OF EXTRAHEPATIC BILE DUCTS
156.2 MALIGNANT NEOPLASM OF AMPULLA OF VATER
156.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF GALLBLADDER AND EXTRAHEPATIC BILE DUCTS
156.9 MALIGNANT NEOPLASM OF BILIARY TRACT PART UNSPECIFIED SITE
157.0 MALIGNANT NEOPLASM OF HEAD OF PANCREAS
157.1 MALIGNANT NEOPLASM OF BODY OF PANCREAS
157.2 MALIGNANT NEOPLASM OF TAIL OF PANCREAS
157.3 MALIGNANT NEOPLASM OF PANCREATIC DUCT
157.4 MALIGNANT NEOPLASM OF ISLETS OF LANGERHANS
157.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF PANCREAS
157.9 MALIGNANT NEOPLASM OF PANCREAS PART UNSPECIFIED
158.0 MALIGNANT NEOPLASM OF RETROPERITONEUM
158.8 MALIGNANT NEOPLASM OF SPECIFIED PARTS OF PERITONEUM
158.9 MALIGNANT NEOPLASM OF PERITONEUM UNSPECIFIED
159.0 MALIGNANT NEOPLASM OF INTESTINAL TRACT PART UNSPECIFIED
159.1 MALIGNANT NEOPLASM OF SPLEEN NOT ELSEWHERE CLASSIFIED
159.8 MALIGNANT NEOPLASM OF OTHER SITES OF DIGESTIVE SYSTEM AND INTRA-ABDOMINAL ORGANS
159.9 MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE DIGESTIVE ORGANS AND PERITONEUM
160.0 MALIGNANT NEOPLASM OF NASAL CAVITIES
160.1 MALIGNANT NEOPLASM OF AUDITORY TUBE MIDDLE EAR AND MASTOID AIR CELLS
160.2 MALIGNANT NEOPLASM OF MAXILLARY SINUS
160.3 MALIGNANT NEOPLASM OF ETHMOIDAL SINUS
160.4 MALIGNANT NEOPLASM OF FRONTAL SINUS
160.5 MALIGNANT NEOPLASM OF SPHENOIDAL SINUS
160.8 MALIGNANT NEOPLASM OF OTHER ACCESSORY SINUSES
160.9 MALIGNANT NEOPLASM OF ACCESSORY SINUS UNSPECIFIED
161.0 MALIGNANT NEOPLASM OF GLOTTIS
161.1 MALIGNANT NEOPLASM OF SUPRAGLOTTIS
161.2 MALIGNANT NEOPLASM OF SUBGLOTTIS
161.3 MALIGNANT NEOPLASM OF LARYNGEAL CARTILAGES
161.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF LARYNX
161.9 MALIGNANT NEOPLASM OF LARYNX UNSPECIFIED
162.0 MALIGNANT NEOPLASM OF TRACHEA
162.2 MALIGNANT NEOPLASM OF MAIN BRONCHUS
162.3 MALIGNANT NEOPLASM OF UPPER LOBE BRONCHUS OR LUNG
162.4 MALIGNANT NEOPLASM OF MIDDLE LOBE BRONCHUS OR LUNG
162.5 MALIGNANT NEOPLASM OF LOWER LOBE BRONCHUS OR LUNG
162.8 MALIGNANT NEOPLASM OF OTHER PARTS OF BRONCHUS OR LUNG
162.9 MALIGNANT NEOPLASM OF BRONCHUS AND LUNG UNSPECIFIED
163.0 MALIGNANT NEOPLASM OF PARIETAL PLEURA
163.1 MALIGNANT NEOPLASM OF VISCERAL PLEURA
163.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF PLEURA
163.9 MALIGNANT NEOPLASM OF PLEURA UNSPECIFIED
164.0 MALIGNANT NEOPLASM OF THYMUS
164.1 MALIGNANT NEOPLASM OF HEART
164.2 MALIGNANT NEOPLASM OF ANTERIOR MEDIASTINUM
164.3 MALIGNANT NEOPLASM OF POSTERIOR MEDIASTINUM
164.8 MALIGNANT NEOPLASM OF OTHER PARTS OF MEDIASTINUM
164.9 MALIGNANT NEOPLASM OF MEDIASTINUM PART UNSPECIFIED
165.0 MALIGNANT NEOPLASM OF UPPER RESPIRATORY TRACT PART UNSPECIFIED
165.8 MALIGNANT NEOPLASM OF OTHER SITES WITHIN THE RESPIRATORY SYSTEM AND INTRATHORACIC ORGANS
165.9 MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE RESPIRATORY SYSTEM
170.0 MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE EXCEPT MANDIBLE
170.1 MALIGNANT NEOPLASM OF MANDIBLE
170.2 MALIGNANT NEOPLASM OF VERTEBRAL COLUMN EXCLUDING SACRUM AND COCCYX
170.3 MALIGNANT NEOPLASM OF RIBS STERNUM AND CLAVICLE
170.4 MALIGNANT NEOPLASM OF SCAPULA AND LONG BONES OF UPPER LIMB
170.5 MALIGNANT NEOPLASM OF SHORT BONES OF UPPER LIMB
170.6 MALIGNANT NEOPLASM OF PELVIC BONES SACRUM AND COCCYX
170.7 MALIGNANT NEOPLASM OF LONG BONES OF LOWER LIMB
170.8 MALIGNANT NEOPLASM OF SHORT BONES OF LOWER LIMB
170.9 MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE SITE UNSPECIFIED
171.0 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK
171.2 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF UPPER LIMB INCLUDING SHOULDER
171.3 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF LOWER LIMB INCLUDING HIP
171.4 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF THORAX
171.5 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF ABDOMEN
171.6 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF PELVIS
171.7 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF TRUNK UNSPECIFIED
171.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF CONNECTIVE AND OTHER SOFT TISSUE
171.9 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE SITE UNSPECIFIED
172.0 MALIGNANT MELANOMA OF SKIN OF LIP
172.1 MALIGNANT MELANOMA OF SKIN OF EYELID INCLUDING CANTHUS
172.2 MALIGNANT MELANOMA OF SKIN OF EAR AND EXTERNAL AUDITORY CANAL
172.3 MALIGNANT MELANOMA OF SKIN OF OTHER AND UNSPECIFIED PARTS OF FACE
172.4 MALIGNANT MELANOMA OF SKIN OF SCALP AND NECK
172.5 MALIGNANT MELANOMA OF SKIN OF TRUNK EXCEPT SCROTUM
172.6 MALIGNANT MELANOMA OF SKIN OF UPPER LIMB INCLUDING SHOULDER
172.7 MALIGNANT MELANOMA OF SKIN OF LOWER LIMB INCLUDING HIP
172.8 MALIGNANT MELANOMA OF OTHER SPECIFIED SITES OF SKIN
172.9 MELANOMA OF SKIN SITE UNSPECIFIED
173.0 OTHER MALIGNANT NEOPLASM OF SKIN OF LIP
173.1 OTHER MALIGNANT NEOPLASM OF SKIN OF EYELID INCLUDING CANTHUS
173.2 OTHER MALIGNANT NEOPLASM OF SKIN OF EAR AND EXTERNAL AUDITORY CANAL
173.3 OTHER MALIGNANT NEOPLASM OF SKIN OF OTHER AND UNSPECIFIED PARTS OF FACE
173.4 OTHER MALIGNANT NEOPLASM OF SCALP AND SKIN OF NECK
173.5 OTHER MALIGNANT NEOPLASM OF SKIN OF TRUNK EXCEPT SCROTUM
173.6 OTHER MALIGNANT NEOPLASM OF SKIN OF UPPER LIMB INCLUDING SHOULDER
173.7 OTHER MALIGNANT NEOPLASM OF SKIN OF LOWER LIMB INCLUDING HIP
173.8 OTHER MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF SKIN
173.9 OTHER MALIGNANT NEOPLASM OF SKIN SITE UNSPECIFIED
174.0 MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST
174.1 MALIGNANT NEOPLASM OF CENTRAL PORTION OF FEMALE BREAST
174.2 MALIGNANT NEOPLASM OF UPPER-INNER QUADRANT OF FEMALE BREAST
174.3 MALIGNANT NEOPLASM OF LOWER-INNER QUADRANT OF FEMALE BREAST
174.4 MALIGNANT NEOPLASM OF UPPER-OUTER QUADRANT OF FEMALE BREAST
174.5 MALIGNANT NEOPLASM OF LOWER-OUTER QUADRANT OF FEMALE BREAST
174.6 MALIGNANT NEOPLASM OF AXILLARY TAIL OF FEMALE BREAST
174.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF FEMALE BREAST
174.9 MALIGNANT NEOPLASM OF BREAST (FEMALE) UNSPECIFIED SITE
175.0 MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF MALE BREAST
175.9 MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST
176.0 KAPOSI'S SARCOMA SKIN
176.1 KAPOSI'S SARCOMA SOFT TISSUE
176.2 KAPOSI'S SARCOMA PALATE
176.3 KAPOSI'S SARCOMA GASTROINTESTINAL SITES
176.4 KAPOSI'S SARCOMA LUNG
176.5 KAPOSI'S SARCOMA LYMPH NODES
176.8 KAPOSI'S SARCOMA OTHER SPECIFIED SITES
176.9 KAPOSI'S SARCOMA UNSPECIFIED SITE
179 MALIGNANT NEOPLASM OF UTERUS-PART UNS
180.0 MALIGNANT NEOPLASM OF ENDOCERVIX
180.1 MALIGNANT NEOPLASM OF EXOCERVIX
180.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF CERVIX
180.9 MALIGNANT NEOPLASM OF CERVIX UTERI UNSPECIFIED SITE
181 MALIGNANT NEOPLASM OF PLACENTA
182.0 MALIGNANT NEOPLASM OF CORPUS UTERI EXCEPT ISTHMUS
182.1 MALIGNANT NEOPLASM OF ISTHMUS
182.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF BODY OF UTERUS
183.0 MALIGNANT NEOPLASM OF OVARY
183.2 MALIGNANT NEOPLASM OF FALLOPIAN TUBE
183.3 MALIGNANT NEOPLASM OF BROAD LIGAMENT OF UTERUS
183.4 MALIGNANT NEOPLASM OF PARAMETRIUM
183.5 MALIGNANT NEOPLASM OF ROUND LIGAMENT OF UTERUS
183.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF UTERINE ADNEXA
183.9 MALIGNANT NEOPLASM OF UTERINE ADNEXA UNSPECIFIED SITE
184.0 MALIGNANT NEOPLASM OF VAGINA
184.1 MALIGNANT NEOPLASM OF LABIA MAJORA
184.2 MALIGNANT NEOPLASM OF LABIA MINORA
184.3 MALIGNANT NEOPLASM OF CLITORIS
184.4 MALIGNANT NEOPLASM OF VULVA UNSPECIFIED SITE
184.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF FEMALE GENITAL ORGANS
184.9 MALIGNANT NEOPLASM OF FEMALE GENITAL ORGAN SITE UNSPECIFIED
185 MALIGNANT NEOPLASM OF PROSTATE
186.0 MALIGNANT NEOPLASM OF UNDESCENDED TESTIS
186.9 MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED TESTIS
187.1 MALIGNANT NEOPLASM OF PREPUCE
187.2 MALIGNANT NEOPLASM OF GLANS PENIS
187.3 MALIGNANT NEOPLASM OF BODY OF PENIS
187.4 MALIGNANT NEOPLASM OF PENIS PART UNSPECIFIED
187.5 MALIGNANT NEOPLASM OF EPIDIDYMIS
187.6 MALIGNANT NEOPLASM OF SPERMATIC CORD
187.7 MALIGNANT NEOPLASM OF SCROTUM
187.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF MALE GENITAL ORGANS
187.9 MALIGNANT NEOPLASM OF MALE GENITAL ORGAN SITE UNSPECIFIED
188.0 MALIGNANT NEOPLASM OF TRIGONE OF URINARY BLADDER
188.1 MALIGNANT NEOPLASM OF DOME OF URINARY BLADDER
188.2 MALIGNANT NEOPLASM OF LATERAL WALL OF URINARY BLADDER
188.3 MALIGNANT NEOPLASM OF ANTERIOR WALL OF URINARY BLADDER
188.4 MALIGNANT NEOPLASM OF POSTERIOR WALL OF URINARY BLADDER
188.5 MALIGNANT NEOPLASM OF BLADDER NECK
188.6 MALIGNANT NEOPLASM OF URETERIC ORIFICE
188.7 MALIGNANT NEOPLASM OF URACHUS
188.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF BLADDER
188.9 MALIGNANT NEOPLASM OF BLADDER PART UNSPECIFIED
189.0 MALIGNANT NEOPLASM OF KIDNEY EXCEPT PELVIS
189.1 MALIGNANT NEOPLASM OF RENAL PELVIS
189.2 MALIGNANT NEOPLASM OF URETER
189.3 MALIGNANT NEOPLASM OF URETHRA
189.4 MALIGNANT NEOPLASM OF PARAURETHRAL GLANDS
189.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF URINARY ORGANS
189.9 MALIGNANT NEOPLASM OF URINARY ORGAN SITE UNSPECIFIED
190.0 MALIGNANT NEOPLASM OF EYEBALL EXCEPT CONJUNCTIVA CORNEA RETINA AND CHOROID
190.1 MALIGNANT NEOPLASM OF ORBIT
190.2 MALIGNANT NEOPLASM OF LACRIMAL GLAND
190.3 MALIGNANT NEOPLASM OF CONJUNCTIVA
190.4 MALIGNANT NEOPLASM OF CORNEA
190.5 MALIGNANT NEOPLASM OF RETINA
190.6 MALIGNANT NEOPLASM OF CHOROID
190.7 MALIGNANT NEOPLASM OF LACRIMAL DUCT
190.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF EYE
190.9 MALIGNANT NEOPLASM OF EYE PART UNSPECIFIED
191.0 MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES
191.1 MALIGNANT NEOPLASM OF FRONTAL LOBE
191.2 MALIGNANT NEOPLASM OF TEMPORAL LOBE
191.3 MALIGNANT NEOPLASM OF PARIETAL LOBE
191.4 MALIGNANT NEOPLASM OF OCCIPITAL LOBE
191.5 MALIGNANT NEOPLASM OF VENTRICLES
191.6 MALIGNANT NEOPLASM OF CEREBELLUM NOS
191.7 MALIGNANT NEOPLASM OF BRAIN STEM
191.8 MALIGNANT NEOPLASM OF OTHER PARTS OF BRAIN
191.9 MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE
192.0 MALIGNANT NEOPLASM OF CRANIAL NERVES
192.1 MALIGNANT NEOPLASM OF CEREBRAL MENINGES
192.2 MALIGNANT NEOPLASM OF SPINAL CORD
192.3 MALIGNANT NEOPLASM OF SPINAL MENINGES
192.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF NERVOUS SYSTEM
192.9 MALIGNANT NEOPLASM OF NERVOUS SYSTEM PART UNSPECIFIED
193 MALIGNANT NEOPLASM OF THYROID GLAND
194.0 MALIGNANT NEOPLASM OF ADRENAL GLAND
194.1 MALIGNANT NEOPLASM OF PARATHYROID GLAND
194.3 MALIGNANT NEOPLASM OF PITUITARY GLAND AND CRANIOPHARYNGEAL DUCT
194.4 MALIGNANT NEOPLASM OF PINEAL GLAND
194.5 MALIGNANT NEOPLASM OF CAROTID BODY
194.6 MALIGNANT NEOPLASM OF AORTIC BODY AND OTHER PARAGANGLIA
194.8 MALIGNANT NEOPLASM OF OTHER ENDOCRINE GLANDS AND RELATED STRUCTURES
194.9 MALIGNANT NEOPLASM OF ENDOCRINE GLAND SITE UNSPECIFIED
195.0 MALIGNANT NEOPLASM OF HEAD FACE AND NECK
195.1 MALIGNANT NEOPLASM OF THORAX
195.2 MALIGNANT NEOPLASM OF ABDOMEN
195.3 MALIGNANT NEOPLASM OF PELVIS
195.4 MALIGNANT NEOPLASM OF UPPER LIMB
195.5 MALIGNANT NEOPLASM OF LOWER LIMB
195.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES
196.0 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF HEAD FACE AND NECK
196.1 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF INTRATHORACIC LYMPH NODES
196.2 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF INTRA-ABDOMINAL LYMPH NODES
196.3 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF AXILLA AND UPPER LIMB
196.5 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
196.6 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF INTRAPELVIC LYMPH NODES
196.8 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF MULTIPLE SITES
196.9 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES SITE UNSPECIFIED
197.0 SECONDARY MALIGNANT NEOPLASM OF LUNG
197.1 SECONDARY MALIGNANT NEOPLASM OF MEDIASTINUM
197.2 SECONDARY MALIGNANT NEOPLASM OF PLEURA
197.3 SECONDARY MALIGNANT NEOPLASM OF OTHER RESPIRATORY ORGANS
197.4 SECONDARY MALIGNANT NEOPLASM OF SMALL INTESTINE INCLUDING DUODENUM
197.5 SECONDARY MALIGNANT NEOPLASM OF LARGE INTESTINE AND RECTUM
197.6 SECONDARY MALIGNANT NEOPLASM OF RETROPERITONEUM AND PERITONEUM
197.7 MALIGNANT NEOPLASM OF LIVER SECONDARY
197.8 SECONDARY MALIGNANT NEOPLASM OF OTHER DIGESTIVE ORGANS AND SPLEEN
198.0 SECONDARY MALIGNANT NEOPLASM OF KIDNEY
198.1 SECONDARY MALIGNANT NEOPLASM OF OTHER URINARY ORGANS
198.2 SECONDARY MALIGNANT NEOPLASM OF SKIN
198.3 SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD
198.4 SECONDARY MALIGNANT NEOPLASM OF OTHER PARTS OF NERVOUS SYSTEM
198.5 SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW
198.6 SECONDARY MALIGNANT NEOPLASM OF OVARY
198.7 SECONDARY MALIGNANT NEOPLASM OF ADRENAL GLAND
198.81 SECONDARY MALIGNANT NEOPLASM OF BREAST
198.82 SECONDARY MALIGNANT NEOPLASM OF GENITAL ORGANS
198.89 SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES
199.0 DISSEMINATED MALIGNANT NEOPLASM
199.1 OTHER MALIGNANT NEOPLASM OF UNSPECIFIED SITE
199.2 MALIGNANT NEOPLASM ASSOCIATED WITH TRANSPLANT ORGAN
200.00 RETICULOSARCOMA UNSPECIFIED SITE
200.01 RETICULOSARCOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK
200.02 RETICULOSARCOMA INVOLVING INTRATHORACIC LYMPH NODES
200.03 RETICULOSARCOMA INVOLVING INTRA-ABDOMINAL LYMPH NODES
200.04 RETICULOSARCOMA INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
200.05 RETICULOSARCOMA INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
200.06 RETICULOSARCOMA INVOLVING INTRAPELVIC LYMPH NODES
200.07 RETICULOSARCOMA INVOLVING SPLEEN
200.08 RETICULOSARCOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
200.10 LYMPHOSARCOMA UNSPECIFIED SITE
200.11 LYMPHOSARCOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK
200.12 LYMPHOSARCOMA INVOLVING INTRATHORACIC LYMPH NODES
200.13 LYMPHOSARCOMA INVOLVING INTRA-ABDOMINAL LYMPH NODES
200.14 LYMPHOSARCOMA INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
200.15 LYMPHOSARCOMA INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
200.16 LYMPHOSARCOMA INVOLVING INTRAPELVIC LYMPH NODES
200.17 LYMPHOSARCOMA INVOLVING SPLEEN
200.18 LYMPHOSARCOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
200.20 BURKITT'S TUMOR OR LYMPHOMA UNSPECIFIED SITE
200.21 BURKITT'S TUMOR OR LYMPHOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK
200.22 BURKITT'S TUMOR OR LYMPHOMA INVOLVING INTRATHORACIC LYMPH NODES
200.23 BURKITT'S TUMOR OR LYMPHOMA INVOLVING INTRA-ABDOMINAL LYMPH NODES
200.24 BURKITT'S TUMOR OR LYMPHOMA INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
200.25 BURKITT'S TUMOR OR LYMPHOMA INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
200.26 BURKITT'S TUMOR OR LYMPHOMA INVOLVING INTRAPELVIC LYMPH NODES
200.27 BURKITT'S TUMOR OR LYMPHOMA INVOLVING SPLEEN
200.28 BURKITT'S TUMOR OR LYMPHOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
200.30 MARGINAL ZONE LYMPHOMA, UNSPECIFIED SITE, EXTRANODAL AND SOLID ORGAN SITES
200.31 MARGINAL ZONE LYMPHOMA,LYMPH NODES OF HEAD, FACE, AND NECK
200.32 MARGINAL ZONE LYMPHOMA,INTRATHORACIC LYMPH NODES
200.33 MARGINAL ZONE LYMPHOMA, INTRAABDOMINAL LYMPH NODES
200.34 MARGINAL ZONE LYMPHOMA, LYMPH NODES OF AXILLA AND UPPER LIMB
200.35 MARGINAL ZONE LYMPHOMA, LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
200.36 MARGINAL ZONE LYMPHOMA, INTRAPELVIC LYMPH NODES
200.37 MARGINAL ZONE LYMPHOMA, SPLEEN
200.38 MARGINAL ZONE LYMPHOMA, LYMPH NODES OF MULTIPLE SITES
200.40 MANTLE CELL LYMPHOMA, UNSPECIFIED SITE, EXTRANODAL AND SOLID ORGAN SITES
200.41 MANTLE CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
200.42 MANTLE CELL LYMPHOMA, INTRATHORACIC LYMPH NODES
200.43 MANTLE CELL LYMPHOMA, INTRA-ABDOMINAL LYMPH NODES
200.44 MANTLE CELL LYMPHOMA, LYMPH NODES OF AXILLA AND UPPER LIMB
200.45 MANTLE CELL LYMPHOMA, LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
200.46 MANTLE CELL LYMPHOMA, INTRAPELVIC LYMPH NODES
200.47 MANTLE CELL LYMPHOMA, SPLEEN
200.48 MANTLE CELL LYMPHOMA, LYMPH NODES OF MULTIPLE SITES
200.50 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, UNSPECIFIED SITE, EXTRANODAL AND SOLID ORGAN SITES
200.51 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
200.52 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, INTRATHORACIC LYMPH NODES
200.53 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, INTRA-ABDOMINAL LYMPH NODES
200.54 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, LYMPH NODES OF AXILLA AND UPPER LIMB
200.55 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
200.56 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, INTRAPELVIC LYMPH NODES
200.57 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, SPLEEN
200.58 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, LYMPH NODES OF MULTIPLE SITES
200.60 ANAPLASTIC LARGE CELL LYMPHOMA, UNSPECIFIED SITE, EXTRANODAL AND SOLID ORGAN SITES
200.61 ANAPLASTIC LARGE CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
200.62 ANAPLASTIC LARGE CELL LYMPHOMA, INTRATHORACIC LYMPH NODES
200.63 ANAPLASTIC LARGE CELL LYMPHOMA, INTRA-ABDOMINAL LYMPH NODES
200.64 ANAPLASTIC LARGE CELL LYMPHOMA, LYMPH NODES OF AXILLA AND UPPER LIMB
200.65 ANAPLASTIC LARGE CELL LYMPHOMA, LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
200.66 ANAPLASTIC LARGE CELL LYMPHOMA, INTRAPELVIC LYMPH NODES
200.67 ANAPLASTIC LARGE CELL LYMPHOMA, SPLEEN
200.68 ANAPLASTIC LARGE CELL LYMPHOMA, LYMPH NODES OF MULTIPLE SITES
200.70 LARGE CELL LYMPHOMA, UNSPECIFIED SITE, EXTRANODAL AND SOLID ORGAN SITES
200.71 LARGE CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
200.72 LARGE CELL LYMPHOMA, INTRATHORACIC LYMPH NODES
200.73 LARGE CELL LYMPHOMA, INTRA-ABDOMINAL LYMPH NODES
200.74 LARGE CELL LYMPHOMA, LYMPH NODES OF AXILLA AND UPPER LIMB
200.75 LARGE CELL LYMPHOMA, LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
200.76 LARGE CELL LYMPHOMA, INTRAPELVIC LYMPH NODES
200.77 LARGE CELL LYMPHOMA, SPLEEN
200.78 LARGE CELL LYMPHOMA, LYMPH NODES OF MULTIPLE SITES
200.80 OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA UNSPECIFIED SITE
200.81 OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK
200.82 OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING INTRATHORACIC LYMPH NODES
200.83 OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING INTRA-ABDOMINAL LYMPH NODES
200.84 OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
200.85 OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
200.86 OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING INTRAPELVIC LYMPH NODES
200.87 OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING SPLEEN
200.88 OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
201.00 HODGKIN'S PARAGRANULOMA UNSPECIFIED SITE
201.01 HODGKIN'S PARAGRANULOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK
201.02 HODGKIN'S PARAGRANULOMA INVOLVING INTRATHORACIC LYMPH NODES
201.03 HODGKIN'S PARAGRANULOMA INVOLVING INTRA-ABDOMINAL LYMPH NODES
201.04 HODGKIN'S PARAGRANULOMA INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
201.05 HODGKIN'S PARAGRANULOMA INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
201.06 HODGKIN'S PARAGRANULOMA INVOLVING INTRAPELVIC LYMPH NODES
201.07 HODGKIN'S PARAGRANULOMA INVOLVING SPLEEN
201.08 HODGKIN'S PARAGRANULOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
201.10 HODGKIN'S GRANULOMA UNSPECIFIED SITE
201.11 HODGKIN'S GRANULOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK
201.12 HODGKIN'S GRANULOMA INVOLVING INTRATHORACIC LYMPH NODES
201.13 HODGKIN'S GRANULOMA INVOLVING INTRA-ABDOMINAL LYMPH NODES
201.14 HODGKIN'S GRANULOMA INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
201.15 HODGKIN'S GRANULOMA INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
201.16 HODGKIN'S GRANULOMA INVOLVING INTRAPELVIC LYMPH NODES
201.17 HODGKIN'S GRANULOMA INVOLVING SPLEEN
201.18 HODGKIN'S GRANULOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
201.20 HODGKIN'S SARCOMA UNSPECIFIED SITE
201.21 HODGKIN'S SARCOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK
201.22 HODGKIN'S SARCOMA INVOLVING INTRATHORACIC LYMPH NODES
201.23 HODGKIN'S SARCOMA INVOLVING INTRA-ABDOMINAL LYMPH NODES
201.24 HODGKIN'S SARCOMA INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
201.25 HODGKIN'S SARCOMA INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
201.26 HODGKIN'S SARCOMA INVOLVING INTRAPELVIC LYMPH NODES
201.27 HODGKIN'S SARCOMA INVOLVING SPLEEN
201.28 HODGKIN'S SARCOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
201.40 HODGKIN'S DISEASE LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE UNSPECIFIED SITE
201.41 HODGKIN'S DISEASE LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE INVOLVING LYMPH NODES OF HEAD FACE AND NECK
201.42 HODGKIN'S DISEASE LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE INVOLVING INTRATHORACIC LYMPH NODES
201.43 HODGKIN'S DISEASE LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE INVOLVING INTRA-ABDOMINAL LYMPH NODES
201.44 HODGKIN'S DISEASE LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
201.45 HODGKIN'S DISEASE LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
201.46 HODGKIN'S DISEASE LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE INVOLVING INTRAPELVIC LYMPH NODES
201.47 HODGKIN'S DISEASE LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE INVOLVING SPLEEN
201.48 HODGKIN'S DISEASE LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE INVOLVING LYMPH NODES OF MULTIPLE SITES
201.50 HODGKIN'S DISEASE NODULAR SCLEROSIS UNSPECIFIED SITE
201.51 HODGKIN'S DISEASE NODULAR SCLEROSIS INVOLVING LYMPH NODES OF HEAD FACE AND NECK
201.52 HODGKIN'S DISEASE NODULAR SCLEROSIS INVOLVING INTRATHORACIC LYMPH NODES
201.53 HODGKIN'S DISEASE NODULAR SCLEROSIS INVOLVING INTRA-ABDOMINAL LYMPH NODES
201.54 HODGKIN'S DISEASE NODULAR SCLEROSIS INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
201.55 HODGKIN'S DISEASE NODULAR SCLEROSIS INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
201.56 HODGKIN'S DISEASE NODULAR SCLEROSIS INVOLVING INTRAPELVIC LYMPH NODES
201.57 HODGKIN'S DISEASE NODULAR SCLEROSIS INVOLVING SPLEEN
201.58 HODGKIN'S DISEASE NODULAR SCLEROSIS INVOLVING LYMPH NODES OF MULTIPLE SITES
201.60 HODGKIN'S DISEASE MIXED CELLULARITY UNSPECIFIED SITE
201.61 HODGKIN'S DISEASE MIXED CELLULARITY INVOLVING LYMPH NODES OF HEAD FACE AND NECK
201.62 HODGKIN'S DISEASE MIXED CELLULARITY INVOLVING INTRATHORACIC LYMPH NODES
201.63 HODGKIN'S DISEASE MIXED CELLULARITY INVOLVING INTRA-ABDOMINAL LYMPH NODES
201.64 HODGKIN'S DISEASE MIXED CELLULARITY INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
201.65 HODGKIN'S DISEASE MIXED CELLULARITY INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
201.66 HODGKIN'S DISEASE MIXED CELLULARITY INVOLVING INTRAPELVIC LYMPH NODES
201.67 HODGKIN'S DISEASE MIXED CELLULARITY INVOLVING SPLEEN
201.68 HODGKIN'S DISEASE MIXED CELLULARITY INVOLVING LYMPH NODES OF MULTIPLE SITES
201.70 HODGKIN'S DISEASE LYMPHOCYTIC DEPLETION UNSPECIFIED SITE
201.71 HODGKIN'S DISEASE LYMPHOCYTIC DEPLETION INVOLVING LYMPH NODES OF HEAD FACE AND NECK
201.72 HODGKIN'S DISEASE LYMPHOCYTIC DEPLETION INVOLVING INTRATHORACIC LYMPH NODES
201.73 HODGKIN'S DISEASE LYMPHOCYTIC DEPLETION INVOLVING INTRA-ABDOMINAL LYMPH NODES
201.74 HODGKIN'S DISEASE LYMPHOCYTIC DEPLETION INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
201.75 HODGKIN'S DISEASE LYMPHOCYTIC DEPLETION INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
201.76 HODGKIN'S DISEASE LYMPHOCYTIC DEPLETION INVOLVING INTRAPELVIC LYMPH NODES
201.77 HODGKIN'S DISEASE LYMPHOCYTIC DEPLETION INVOLVING SPLEEN
201.78 HODGKIN'S DISEASE LYMPHOCYTIC DEPLETION INVOLVING LYMPH NODES OF MULTIPLE SITES
201.90 HODGKIN'S DISEASE UNSPECIFIED TYPE UNSPECIFIED SITE
201.91 HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING LYMPH NODES OF HEAD FACE AND NECK
201.92 HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING INTRATHORACIC LYMPH NODES
201.93 HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING INTRA-ABDOMINAL LYMPH NODES
201.94 HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
201.95 HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
201.96 HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING INTRAPELVIC LYMPH NODES
201.97 HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING SPLEEN
201.98 HODGKIN'S DISEASE UNSPECIFIED TYPE INVOLVING LYMPH NODES OF MULTIPLE SITES
202.00 NODULAR LYMPHOMA UNSPECIFIED SITE
202.01 NODULAR LYMPHOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK
202.02 NODULAR LYMPHOMA INVOLVING INTRATHORACIC LYMPH NODES
202.03 NODULAR LYMPHOMA INVOLVING INTRA-ABDOMINAL LYMPH NODES
202.04 NODULAR LYMPHOMA INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
202.05 NODULAR LYMPHOMA INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
202.06 NODULAR LYMPHOMA INVOLVING INTRAPELVIC LYMPH NODES
202.07 NODULAR LYMPHOMA INVOLVING SPLEEN
202.08 NODULAR LYMPHOMA INVOLVING LYMPH NODES OF MULTIPLE SITES
202.10 MYCOSIS FUNGOIDES UNSPECIFIED SITE
202.11 MYCOSIS FUNGOIDES INVOLVING LYMPH NODES OF HEAD FACE AND NECK
202.12 MYCOSIS FUNGOIDES INVOLVING INTRATHORACIC LYMPH NODES
202.13 MYCOSIS FUNGOIDES INVOLVING INTRA-ABDOMINAL LYMPH NODES
202.14 MYCOSIS FUNGOIDES INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
202.15 MYCOSIS FUNGOIDES INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
202.16 MYCOSIS FUNGOIDES INVOLVING INTRAPELVIC LYMPH NODES
202.17 MYCOSIS FUNGOIDES INVOLVING SPLEEN
202.18 MYCOSIS FUNGOIDES INVOLVING LYMPH NODES OF MULTIPLE SITES
202.20 SEZARY'S DISEASE UNSPECIFIED SITE
202.21 SEZARY'S DISEASE INVOLVING LYMPH NODES OF HEAD FACE AND NECK
202.22 SEZARY'S DISEASE INVOLVING INTRATHORACIC LYMPH NODES
202.23 SEZARY'S DISEASE INVOLVING INTRA-ABDOMINAL LYMPH NODES
202.24 SEZARY'S DISEASE INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
202.25 SEZARY'S DISEASE INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
202.26 SEZARY'S DISEASE INVOLVING INTRAPELVIC LYMPH NODES
202.27 SEZARY'S DISEASE INVOLVING SPLEEN
202.28 SEZARY'S DISEASE INVOLVING LYMPH NODES OF MULTIPLE SITES
202.30 MALIGNANT HISTIOCYTOSIS UNSPECIFIED SITE
202.31 MALIGNANT HISTIOCYTOSIS INVOLVING LYMPH NODES OF HEAD FACE AND NECK
202.32 MALIGNANT HISTIOCYTOSIS INVOLVING INTRATHORACIC LYMPH NODES
202.33 MALIGNANT HISTIOCYTOSIS INVOLVING INTRA-ABDOMINAL LYMPH NODES
202.34 MALIGNANT HISTIOCYTOSIS INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
202.35 MALIGNANT HISTIOCYTOSIS INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
202.36 MALIGNANT HISTIOCYTOSIS INVOLVING INTRAPELVIC LYMPH NODES
202.37 MALIGNANT HISTIOCYTOSIS INVOLVING SPLEEN
202.38 MALIGNANT HISTIOCYTOSIS INVOLVING LYMPH NODES OF MULTIPLE SITES
202.40 LEUKEMIC RETICULOENDOTHELIOSIS UNSPECIFIED SITE
202.41 LEUKEMIC RETICULOENDOTHELIOSIS INVOLVING LYMPH NODES OF HEAD FACE AND NECK
202.42 LEUKEMIC RETICULOENDOTHELIOSIS INVOLVING INTRATHORACIC LYMPH NODES
202.43 LEUKEMIC RETICULOENDOTHELIOSIS INVOLVING INTRA-ABDOMINAL LYMPH NODES
202.44 LEUKEMIC RETICULOENDOTHELIOSIS INVOLVING LYMPH NODES OF AXILLA AND UPPER ARM
202.45 LEUKEMIC RETICULOENDOTHELIOSIS INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
202.46 LEUKEMIC RETICULOENDOTHELIOSIS INVOLVING INTRAPELVIC LYMPH NODES
202.47 LEUKEMIC RETICULOENDOTHELIOSIS INVOLVING SPLEEN
202.48 LEUKEMIC RETICULOENDOTHELIOSIS INVOLVING LYMPH NODES OF MULTIPLE SITES
202.50 LETTERER-SIWE DISEASE UNSPECIFIED SITE
202.51 LETTERER-SIWE DISEASE INVOLVING LYMPH NODES OF HEAD FACE AND NECK
202.52 LETTERER-SIWE DISEASE INVOLVING INTRATHORACIC LYMPH NODES
202.53 LETTERER-SIWE DISEASE INVOLVING INTRA-ABDOMINAL LYMPH NODES
202.54 LETTERER-SIWE DISEASE INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
202.55 LETTERER-SIWE DISEASE INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
202.56 LETTERER-SIWE DISEASE INVOLVING INTRAPELVIC LYMPH NODES
202.57 LETTERER-SIWE DISEASE INVOLVING SPLEEN
202.58 LETTERER-SIWE DISEASE INVOLVING LYMPH NODES OF MULTIPLE SITES
202.60 MALIGNANT MAST CELL TUMORS UNSPECIFIED SITE
202.61 MALIGNANT MAST CELL TUMORS INVOLVING LYMPH NODES OF HEAD FACE AND NECK
202.62 MALIGNANT MAST CELL TUMORS INVOLVING INTRATHORACIC LYMPH NODES
202.63 MALIGNANT MAST CELL TUMORS INVOLVING INTRA-ABDOMINAL LYMPH NODES
202.64 MALIGNANT MAST CELL TUMORS INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
202.65 MALIGNANT MAST CELL TUMORS INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
202.66 MALIGNANT MAST CELL TUMORS INVOLVING INTRAPELVIC LYMPH NODES
202.67 MALIGNANT MAST CELL TUMORS INVOLVING SPLEEN
202.68 MALIGNANT MAST CELL TUMORS INVOLVING LYMPH NODES OF MULTIPLE SITES
202.70 PERIPHERAL T CELL LYMPHOMA, UNSPECIFIED SITE, EXTRANODAL AND SOLID ORGAN SITES
202.71 PERIPHERAL T CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK
202.72 PERIPHERAL T CELL LYMPHOMA, INTRATHORACIC LYMPH NODES
202.73 PERIPHERAL T CELL LYMPHOMA, INTRA-ABDOMINAL LYMPH NODES
202.74 PERIPHERAL T CELL LYMPHOMA, LYMPH NODES OF AXILLA AND UPPER LIMB
202.75 PERIPHERAL T CELL LYMPHOMA, LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
202.76 PERIPHERAL T CELL LYMPHOMA, INTRAPELVIC LYMPH NODES
202.77 PERIPHERAL T CELL LYMPHOMA, SPLEEN
202.78 PERIPHERAL T CELL LYMPHOMA, LYMPH NODES OF MULTIPLE SITES
202.80 OTHER MALIGNANT LYMPHOMAS UNSPECIFIED SITE
202.81 OTHER MALIGNANT LYMPHOMAS INVOLVING LYMPH NODES OF HEAD FACE AND NECK
202.82 OTHER MALIGNANT LYMPHOMAS INVOLVING INTRATHORACIC LYMPH NODES
202.83 OTHER MALIGNANT LYMPHOMAS INVOLVING INTRA-ABDOMINAL LYMPH NODES
202.84 OTHER MALIGNANT LYMPHOMAS INVOLVING LYMPH NODES OF AXILLA AND UPPER LIMB
202.85 OTHER MALIGNANT LYMPHOMAS INVOLVING LYMPH NODES OF INGUINAL REGION AND LOWER LIMB
202.86 OTHER MALIGNANT LYMPHOMAS INVOLVING INTRAPELVIC LYMPH NODES
202.87 OTHER MALIGNANT LYMPHOMAS INVOLVING SPLEEN
202.88 OTHER MALIGNANT LYMPHOMAS INVOLVING LYMPH NODES OF MULTIPLE SITES
203.00 MULTIPLE MYELOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
203.01 MULTIPLE MYELOMA IN REMISSION
203.02 MULTIPLE MYELOMA, IN RELAPSE
203.10 PLASMA CELL LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
203.11 PLASMA CELL LEUKEMIA IN REMISSION
203.12 PLASMA CELL LEUKEMIA, IN RELAPSE
203.80 OTHER IMMUNOPROLIFERATIVE NEOPLASMS, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
203.81 OTHER IMMUNOPROLIFERATIVE NEOPLASMS IN REMISSION
203.82 OTHER IMMUNOPROLIFERATIVE NEOPLASMS, IN RELAPSE
204.00 ACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
204.01 LYMPHOID LEUKEMIA ACUTE IN REMISSION
204.02 ACUTE LYMPHOID LEUKEMIA, IN RELAPSE
204.10 CHRONIC LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
204.11 LYMPHOID LEUKEMIA CHRONIC IN REMISSION
204.12 CHRONIC LYMPHOID LEUKEMIA, IN RELAPSE
204.20 SUBACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
204.21 LYMPHOID LEUKEMIA SUBACUTE IN REMISSION
204.22 SUBACUTE LYMPHOID LEUKEMIA, IN RELAPSE
204.80 OTHER LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION
204.81 OTHER LYMPHOID LEUKEMIA IN REMISSION
204.82 OTHER LYMPHOID LEUKEMIA, IN RELAPSE
273.3 MACROGLOBULINEMIA
995.20 UNSPECIFIED ADVERSE EFFECT OF UNSPECIFIED DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE
995.29 UNSPECIFIED ADVERSE EFFECT OF OTHER DRUG, MEDICINAL AND BIOLOGICAL SUBSTANCE
V07.8 OTHER SPECIFIED PROPHYLACTIC OR TREATMENT MEASURE
V66.2 CONVALESCENCE FOLLOWING CHEMOTHERAPY
Diagnoses that Support Medical Necessity
See ICD-9 Codes that Support Medical Necessity.
Documentation Requirements
• Medical record documentation maintained by the ordering/referring provider must substantiate the medical necessity for the use of this drug by clearly indicating the type of cancer being treated as well as the drug(s) used in the chemotherapy treatment(s).
o A medication administration record should also be maintained in each patient’s record.
• For patients on a 14 day dose dense chemotherapy cycle, the chemotherapy record/orders should support this type of schedule is being followed.
Treatment Logic
• Pegfilgrastim (Neulasta TM) is a colony stimulating factor (CSF) that acts on hematopoietic cells by binding to specific cell surface receptors thereby, stimulating proliferation, differentiation, commitment, and end cell functional activation.
• Pegfilgrastim (Neulasta TM) is approved by the Food and Drug Administration to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia.
• Prophylactic use of Neulasta in patients undergoing chemotherapy reduces the risk of febrile neutropenia and infections. Prophylactic therapy can be considered for patients receiving myelosuppressive chemotherapy if the risk of febrile neutropenia is 20% or greater.
Sources of Information and Basis for Decision
American Society of Clinical Oncology Growth Factor Expert Panel. (2000). 2000 Update of recommendations for the use of hematopoietic colony-stimulating factors: Evidence-based, clinical practice guidelines. Available: http://www.asco.org/prof/pp/html/guide/color/m_colorintro.htm.
Drug Facts and Comparisons NEWS. (January 2006). Pegfilgrastim, 2.
FCSO LCD 29254, Pegfilgrastim (Neulasta™), 10/01/2010. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.
Holmes, F., O’Shaughnessy, S., Vukelja, S., et al. (2002). Blinded, randomized, multicenter, study to evaluate single administration pegfilgrastim once per cycle versus daily filgrastim as an adjunct to chemotherapy in patients with high risk stage II or stage III/IV breast cancer. Journal of Clinical Oncology, 20(3), 727-731.
The United States Pharmacopeia Drug Information (USP DI). (November 2005). Oncology drug information. The Association of Community Cancer Centers (ACCC). [On-Line]. Available: www.accc-cancer.org/ .
AMA CPT / ADA CDT Copyright Statement
CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.
© Automated Clinical Guidelines, LLC 2010-2013
Copyright 2006-2018 Automated Clinical Guidelines, LLC. All rights reserved.
