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ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 D07.5

Billable / Specific

Carcinoma in situ of prostate

D07
Block
2
Synonyms
303
LCDs
21
Payer Policies
2
Linked CPTs

About ICD-10-CM D07.5

ICD-10-CM code D07.5 represents Carcinoma in situ of prostate. This is a billable/specific code in the Neoplasms chapter (block D07). The 2026 edition of ICD-10-CM D07.5 became effective on October 1, 2025.

Inclusion Terms / Approximate Synonyms

Clinical terms and conditions classified under D07.5. Per CMS ICD-10-CM Tabular 2026.

  • Prostatic intraepithelial neoplasia III (PIN III)
  • Severe dysplasia of prostate

Type 1 Excludes

Pure excludes, these codes can never be coded together with D07.5. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • dysplasia (mild) (moderate) of prostate (N42.3-)
  • prostatic intraepithelial neoplasia II [PIN II] (N42.3-)

Medicare LCD Coverage for D07.5

Local Coverage Determinations (LCDs) from CMS MACs that list D07.5 as a covered diagnosis.

303 LCDs

Showing top 10 of 303 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Transrectal Ultrasound
Article ID: 57427, Effective: 2024-10-01 00:00:00, 118 covered, 0 non-covered
CPT 76872 →
CMS LCD: Billing and Coding: Transrectal Ultrasound
Article ID: 57427, Effective: 2024-10-01 00:00:00, 118 covered, 0 non-covered
CPT 76873 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74170 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74177 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74160 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74178 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74150 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72194 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 74176 →
CMS LCD: Billing and Coding: CT of the Abdomen and Pelvis
Article ID: 56421, Effective: 2025-11-01 00:00:00, 5389 covered, 0 non-covered
CPT 72192 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing D07.5.

21 policies

4 Aetna

Transrectal Ultrasound - Medical Clinical Policy Bulletins | Aetna
Policy ID: CPB-0001
Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase Fraction
Policy ID: CPB-0351
Tumor Markers
Policy ID: CPB-0352
Prostate Cancer Screening
Policy ID: CPB-0521

5 Medicare

Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
Policy ID: ART-52453
Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
Policy ID: ART-52480
Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy
Policy ID: ART-54768
Billing and Coding: CT of the Abdomen and Pelvis
Policy ID: ART-56421
Billing and Coding: Computerized Axial Tomography (CT), Thorax
Policy ID: ART-56580

CPT Codes Commonly Billed with D07.5

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

2 linkages
  • 76873 CMS LCD: Billing and Coding: Transrectal Ultrasound CMS LCD
  • 76872 CMS LCD: Billing and Coding: Transrectal Ultrasound CMS LCD

Convert D07.5 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
D07.5 2334 00000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 D07.5, Billing FAQ

Is ICD-10 code D07.5 billable? +

Yes, D07.5 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What other names or terms map to D07.5? +

ICD-10 D07.5 includes: Prostatic intraepithelial neoplasia III (PIN III); Severe dysplasia of prostate.

What codes are Type 1 Excludes for D07.5? +

Type 1 Excludes (never code together with D07.5): dysplasia (mild) (moderate) of prostate (N42.3-); prostatic intraepithelial neoplasia II [PIN II] (N42.3-)

What CPT codes are commonly billed with D07.5? +

Procedures frequently paired with D07.5 include: 76873, 76872.

What ICD-9 codes does D07.5 map to? +

Per CMS GEMs, D07.5 maps to ICD-9 codes: 2334. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on July 16, 2026.

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