ICD-10 D49.6
Billable / Specific HCC v28: 12Neoplasm of unspecified behavior of brain
About ICD-10-CM D49.6
ICD-10-CM code D49.6 represents Neoplasm of unspecified behavior of brain. This is a billable/specific code in the Neoplasms chapter (block D49). The 2026 edition of ICD-10-CM D49.6 became effective on October 1, 2025.
Coding Tips for D49.6
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
D49.6 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.
Type 1 Excludes
Pure excludes, these codes can never be coded together with D49.6. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- neoplasm of unspecified behavior of cerebral meninges (D49.7)
- neoplasm of unspecified behavior of cranial nerves (D49.7)
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 D49.6
Local Coverage Determinations (LCDs) from CMS MACs that list D49.6 as a covered diagnosis.
Showing top 10 of 334 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing D49.6.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with D49.6
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 95926 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 95925 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 95938 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 95927 CMS LCD: Billing and Coding: Somatosensory Testing CMS LCD
- 95940 CMS LCD: Billing and Coding: Intraoperative Neurophysiological Testing CMS LCD
- G0453 CMS LCD: Billing and Coding: Intraoperative Neurophysiological Testing CMS LCD
- 95941 CMS LCD: Billing and Coding: Intraoperative Neurophysiological Testing CMS LCD
Convert D49.6 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 |
|---|---|---|
| D49.6 | 2396 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To D49.6
Other codes in section D49 (Neoplasms of unspecified behavior).
ICD-10 D49.6, Billing FAQ
Is ICD-10 code D49.6 billable? +
Yes, D49.6 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for D49.6? +
Type 1 Excludes (never code together with D49.6): neoplasm of unspecified behavior of cerebral meninges (D49.7); neoplasm of unspecified behavior of cranial nerves (D49.7)
Does D49.6 affect Medicare Advantage HCC risk adjustment? +
Yes. D49.6 maps to CMS-HCC v28 category 12. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with D49.6? +
Procedures frequently paired with D49.6 include: 95926, 95925, 95938, 95927, 95940.
What ICD-9 codes does D49.6 map to? +
Per CMS GEMs, D49.6 maps to ICD-9 codes: 2396. 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 17, 2026.
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