Is D49.3 a billable ICD-10-CM code?

Yes. D49.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does D49.3 sit in the tabular list?

Neoplasms (C00-D49), in the block Neoplasms of unspecified behavior (D49).

What cannot be coded together with D49.3?

D49.3 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

D49.3

D49.3 — Neoplasm of unspecified behavior of breast

Billable / specific codeICD-10-CMunspecified

D49.3 is a billable, specific ICD-10-CM code for neoplasm of unspecified behavior of breast. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

neoplasm of unspecified behavior of skin of breast (D49.2)

Other codes that can never be billed with D49.3

These codes carry an Excludes1 note pointing at D49.3. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading D49.3 alone.

D49.2Neoplasm of unspecified behavior of bone, soft tissue, and skin

Risk adjustment

D49.3 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

D49.3 is named in 18 Medicare coverage policies — 18 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52480Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article
A52986Billing and Coding: Biomarkers for Oncology
A53101Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® Update
A54188Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID®

Related codes at this level

Codes that share D49. If D49.3 is not quite right, the correct code is usually one of these.

Questions about D49.3

Is D49.3 a billable ICD-10-CM code?: Yes. D49.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does D49.3 sit in the tabular list?: Neoplasms (C00-D49), in the block Neoplasms of unspecified behavior (D49).
What cannot be coded together with D49.3?: D49.3 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.