ICD-10 D42.9
Billable / Specific HCC v28: 12Neoplasm of uncertain behavior of meninges, unspecified
About ICD-10-CM D42.9
ICD-10-CM code D42.9 represents Neoplasm of uncertain behavior of meninges, unspecified. This is a billable/specific code in the Neoplasms chapter (block D42). The 2026 edition of ICD-10-CM D42.9 became effective on October 1, 2025.
Coding Tips for D42.9
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D42.9 is a CMS-HCC v28 risk-adjustment code (category 12). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for D42.9
Local Coverage Determinations (LCDs) from CMS MACs that list D42.9 as a covered diagnosis.
Showing top 10 of 133 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D42.9.
3 Aetna
5 Medicare
CPT Codes Commonly Billed with D42.9
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
Convert D42.9 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| D42.9 | 2376 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D42.9
Other codes in section D37-D48 (Neoplasms of uncertain behavior, polycythemia vera and myelodysplastic syndromes).
ICD-10 D42.9, Billing FAQ
Is ICD-10 code D42.9 billable? +
Yes, D42.9 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does D42.9 affect Medicare Advantage HCC risk adjustment? +
Yes. D42.9 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with D42.9? +
Procedures frequently paired with D42.9 include: 95940, G0453, 95941.
What ICD-9 codes does D42.9 map to? +
Per CMS GEMs, D42.9 maps to ICD-9 codes: 2376. 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 June 1, 2026.
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