CPT C9726: ICD-10 codes that support medical necessity
These ICD-10-CM diagnoses support medical necessity for CPT C9726 under Medicare coverage policies (LCDs, NCDs, and Billing & Coding articles). Billing CPT C9726 with a diagnosis that isn't covered typically denies as CARC 50 — not medically necessary.
National approximation. Coverage varies by MAC and state — confirm against the specific LCD/NCD and article that applies to your jurisdiction and date of service.
| ICD-10 | Description |
|---|---|
| C18.0 | Malignant neoplasm of cecum |
| C18.1 | Malignant neoplasm of appendix |
| C18.2 | Malignant neoplasm of ascending colon |
| C18.3 | Malignant neoplasm of hepatic flexure |
| C18.4 | Malignant neoplasm of transverse colon |
| C18.5 | Malignant neoplasm of splenic flexure |
| C18.6 | Malignant neoplasm of descending colon |
| C18.7 | Malignant neoplasm of sigmoid colon |
| C18.8 | Malignant neoplasm of overlapping sites of colon |
| C18.9 | Malignant neoplasm of colon, unspecified |
| C19 | Malignant neoplasm of rectosigmoid junction |
| C20 | Malignant neoplasm of rectum |
| C48.0 | Malignant neoplasm of retroperitoneum |
| C49.0 | Malignant neoplasm of connective and soft tissue of head, face and neck |
| C49.11 | Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder |
| C49.12 | Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder |
| C49.21 | Malignant neoplasm of connective and soft tissue of right lower limb, including hip |
| C49.22 | Malignant neoplasm of connective and soft tissue of left lower limb, including hip |
| C49.3 | Malignant neoplasm of connective and soft tissue of thorax |
| C49.4 | Malignant neoplasm of connective and soft tissue of abdomen |
| C49.5 | Malignant neoplasm of connective and soft tissue of pelvis |
| C49.6 | Malignant neoplasm of connective and soft tissue of trunk, unspecified |
| C49.8 | Malignant neoplasm of overlapping sites of connective and soft tissue |
| C49.9 | Malignant neoplasm of connective and soft tissue, unspecified |
| C50.011 | Malignant neoplasm of nipple and areola, right female breast |
| C50.012 | Malignant neoplasm of nipple and areola, left female breast |
| C50.111 | Malignant neoplasm of central portion of right female breast |
| C50.112 | Malignant neoplasm of central portion of left female breast |
| C50.211 | Malignant neoplasm of upper-inner quadrant of right female breast |
| C50.212 | Malignant neoplasm of upper-inner quadrant of left female breast |
| C50.311 | Malignant neoplasm of lower-inner quadrant of right female breast |
| C50.312 | Malignant neoplasm of lower-inner quadrant of left female breast |
| C50.411 | Malignant neoplasm of upper-outer quadrant of right female breast |
| C50.412 | Malignant neoplasm of upper-outer quadrant of left female breast |
| C50.511 | Malignant neoplasm of lower-outer quadrant of right female breast |
| C50.512 | Malignant neoplasm of lower-outer quadrant of left female breast |
| C50.611 | Malignant neoplasm of axillary tail of right female breast |
| C50.612 | Malignant neoplasm of axillary tail of left female breast |
| C50.811 | Malignant neoplasm of overlapping sites of right female breast |
| C50.812 | Malignant neoplasm of overlapping sites of left female breast |
| C50.911 | Malignant neoplasm of unspecified site of right female breast |
| C50.912 | Malignant neoplasm of unspecified site of left female breast |
| C50.A1 | Malignant inflammatory neoplasm of right breast |
| C50.A2 | Malignant inflammatory neoplasm of left breast |
| C53.0 | Malignant neoplasm of endocervix |
| C53.1 | Malignant neoplasm of exocervix |
| C53.8 | Malignant neoplasm of overlapping sites of cervix uteri |
| C53.9 | Malignant neoplasm of cervix uteri, unspecified |
| C54.0 | Malignant neoplasm of isthmus uteri |
| C54.1 | Malignant neoplasm of endometrium |
| C54.2 | Malignant neoplasm of myometrium |
| C54.3 | Malignant neoplasm of fundus uteri |
| C54.8 | Malignant neoplasm of overlapping sites of corpus uteri |
| C54.9 | Malignant neoplasm of corpus uteri, unspecified |
| C55 | Malignant neoplasm of uterus, part unspecified |
| D05.11 | Intraductal carcinoma in situ of right breast |
| D05.12 | Intraductal carcinoma in situ of left breast |
| Z17.0 | Estrogen receptor positive status [ER+] |
Frequently asked questions
Which ICD-10 codes support medical necessity for CPT C9726?
Medicare coverage policies (LCDs/NCDs and Billing & Coding articles) list 58 ICD-10 diagnosis codes that support medical necessity for CPT C9726. The covered codes are listed on this page. Coverage varies by MAC/state — always confirm against the policy that applies to you.
What is a medical-necessity (LCD/NCD) crosswalk?
A claim whose procedure isn't supported by a covered diagnosis denies as "not medically necessary" (CARC 50). CMS coverage policies define which diagnoses justify a procedure; this page is the ICD-10 → CPT C9726 view of that relationship.
More free billing tools: all crosswalks · NCCI edits · Medicare fees · denial codes
Informational only, not coding, billing, or legal advice. Based on CMS Medicare Coverage Database data; verify the current LCD/NCD for your MAC before billing.
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