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MA08.068k
ICD 10 CODES AND NARRATIVES
Brentuximab Vedotin (Adcetris®)


MEDICALLY NECESSARY
C81.10Nodular sclerosis Hodgkin lymphoma, unspecified site
C81.11Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.12Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes
C81.13Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes
C81.14Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.15Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.16Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes
C81.17Nodular sclerosis Hodgkin lymphoma, spleen
C81.18Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites
C81.19Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites
C81.20Mixed cellularity Hodgkin lymphoma, unspecified site
C81.21Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.22Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes
C81.23Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes
C81.24Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.25Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.26Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes
C81.27Mixed cellularity Hodgkin lymphoma, spleen
C81.28Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites
C81.29Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites
C81.30Lymphocyte depleted Hodgkin lymphoma, unspecified site
C81.31Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.32Lymphocyte depleted Hodgkin lymphoma, intrathoracic lymph nodes
C81.33Lymphocyte depleted Hodgkin lymphoma, intra-abdominal lymph nodes
C81.34Lymphocyte depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.35Lymphocyte depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.36Lymphocyte depleted Hodgkin lymphoma, intrapelvic lymph nodes
C81.37Lymphocyte depleted Hodgkin lymphoma, spleen
C81.38Lymphocyte depleted Hodgkin lymphoma, lymph nodes of multiple sites
C81.39Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites
C81.40Lymphocyte-rich Hodgkin lymphoma, unspecified site
C81.41Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.42Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes
C81.43Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes
C81.44Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.45Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.46Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes
C81.47Lymphocyte-rich Hodgkin lymphoma, spleen
C81.48Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites
C81.49Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites
C81.70Other Hodgkin lymphoma, unspecified site
C81.71Other Hodgkin lymphoma, lymph nodes of head, face, and neck
C81.72Other Hodgkin lymphoma, intrathoracic lymph nodes
C81.73Other Hodgkin lymphoma, intra-abdominal lymph nodes
C81.74Other Hodgkin lymphoma, lymph nodes of axilla and upper limb
C81.75Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C81.76Other Hodgkin lymphoma, intrapelvic lymph nodes
C81.77Other Hodgkin lymphoma, spleen
C81.78Other Hodgkin lymphoma, lymph nodes of multiple sites
C81.79Other Hodgkin lymphoma, extranodal and solid organ sites
C81.90Hodgkin lymphoma, unspecified, unspecified site
​C81.91Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck
C81.92Hodgkin lymphoma, unspecified, intrathoracic lymph nodes
C81.93Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes
C81.94Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb
C81.95Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C81.96Hodgkin lymphoma, unspecified, intrapelvic lymph nodes
C81.97Hodgkin lymphoma, unspecified, spleen​
C81.98Hodgkin lymphoma, unspecified, lymph nodes of multiple sites
C81.99Hodgkin lymphoma, unspecified, extranodal and solid organ sites
C82.00Follicular lymphoma grade I, unspecified site
C82.01Follicular lymphoma grade I, lymph nodes of head, face, and neck
C82.02Follicular lymphoma grade I, intrathoracic lymph nodes
C82.03Follicular lymphoma grade I, intra-abdominal lymph nodes
C82.04Follicular lymphoma grade I, lymph nodes of axilla and upper limb
C82.05Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb
C82.06Follicular lymphoma grade I, intrapelvic lymph nodes
C82.07Follicular lymphoma grade I, spleen
C82.08Follicular lymphoma grade I, lymph nodes of multiple sites
C82.09Follicular lymphoma grade I, extranodal and solid organ sites
C82.10Follicular lymphoma grade II, unspecified site
C82.11Follicular lymphoma grade II, lymph nodes of head, face, and neck
C82.12Follicular lymphoma grade II, intrathoracic lymph nodes
C82.13Follicular lymphoma grade II, intra-abdominal lymph nodes
C82.14Follicular lymphoma grade II, lymph nodes of axilla and upper limb
C82.15Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb
C82.16Follicular lymphoma grade II, intrapelvic lymph nodes
C82.17Follicular lymphoma grade II, spleen
C82.18Follicular lymphoma grade II, lymph nodes of multiple sites
C82.19Follicular lymphoma grade II, extranodal and solid organ sites
C82.20Follicular lymphoma grade III, unspecified, unspecified site
C82.21Follicular lymphoma grade III, unspecified, lymph nodes of head, face, and neck
C82.22Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes
C82.23Follicular lymphoma grade III, unspecified, intra-abdominal lymph nodes
C82.24Follicular lymphoma grade III, unspecified, lymph nodes of axilla and upper limb
C82.25Follicular lymphoma grade III, unspecified, lymph nodes of inguinal region and lower limb
C82.26Follicular lymphoma grade III, unspecified, intrapelvic lymph nodes
C82.27Follicular lymphoma grade III, unspecified, spleen
C82.28Follicular lymphoma grade III, unspecified, lymph nodes of multiple sites
C82.29Follicular lymphoma grade III, unspecified, extranodal and solid organ sites
C82.30Follicular lymphoma grade IIIa, unspecified site
C82.31Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck
C82.32Follicular lymphoma grade IIIa, intrathoracic lymph nodes
C82.33Follicular lymphoma grade IIIa, intra-abdominal lymph nodes
C82.34Follicular lymphoma grade IIIa, lymph nodes of axilla and upper limb
C82.35Follicular lymphoma grade IIIa, lymph nodes of inguinal region and lower limb
C82.36Follicular lymphoma grade IIIa, intrapelvic lymph nodes
C82.37Follicular lymphoma grade IIIa, spleen
C82.38Follicular lymphoma grade IIIa, lymph nodes of multiple sites
C82.39Follicular lymphoma grade IIIa, extranodal and solid organ sites
C82.40Follicular lymphoma grade IIIb, unspecified site
C82.41Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck
C82.42Follicular lymphoma grade IIIb, intrathoracic lymph nodes
C82.43Follicular lymphoma grade IIIb, intra-abdominal lymph nodes
C82.44Follicular lymphoma grade IIIb, lymph nodes of axilla and upper limb
C82.45Follicular lymphoma grade IIIb, lymph nodes of inguinal region and lower limb
C82.46Follicular lymphoma grade IIIb, intrapelvic lymph nodes
C82.47Follicular lymphoma grade IIIb, spleen
C82.48Follicular lymphoma grade IIIb, lymph nodes of multiple sites
C82.49Follicular lymphoma grade IIIb, extranodal and solid organ sites
C82.50Diffuse follicle center lymphoma, unspecified site
C82.51Diffuse follicle center lymphoma, lymph nodes of head, face, and neck
C82.52Diffuse follicle center lymphoma, intrathoracic lymph nodes
C82.53Diffuse follicle center lymphoma, intra-abdominal lymph nodes
C82.54Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb
C82.55Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.56Diffuse follicle center lymphoma, intrapelvic lymph nodes
C82.57Diffuse follicle center lymphoma, spleen
C82.58Diffuse follicle center lymphoma, lymph nodes of multiple sites
C82.59Diffuse follicle center lymphoma, extranodal and solid organ sites
C82.60Cutaneous follicle center lymphoma, unspecified site
C82.61Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck
C82.62Cutaneous follicle center lymphoma, intrathoracic lymph nodes
C82.63Cutaneous follicle center lymphoma, intra-abdominal lymph nodes
C82.64Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb
C82.65Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb
C82.66Cutaneous follicle center lymphoma, intrapelvic lymph nodes
C82.67Cutaneous follicle center lymphoma, spleen
C82.68Cutaneous follicle center lymphoma, lymph nodes of multiple sites
C82.69Cutaneous follicle center lymphoma, extranodal and solid organ sites
C82.80Other types of follicular lymphoma, unspecified site
C82.81Other types of follicular lymphoma, lymph nodes of head, face, and neck
C82.82Other types of follicular lymphoma, intrathoracic lymph nodes
C82.83Other types of follicular lymphoma, intra-abdominal lymph nodes
C82.84Other types of follicular lymphoma, lymph nodes of axilla and upper limb
C82.85Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb
C82.86Other types of follicular lymphoma, intrapelvic lymph nodes
C82.87Other types of follicular lymphoma, spleen
C82.88Other types of follicular lymphoma, lymph nodes of multiple sites
C82.89Other types of follicular lymphoma, extranodal and solid organ sites
C82.90Follicular lymphoma, unspecified, unspecified site
C82.91Follicular lymphoma, unspecified, lymph nodes of head, face, and neck
C82.92Follicular lymphoma, unspecified, intrathoracic lymph nodes
C82.93Follicular lymphoma, unspecified, intra-abdominal lymph nodes
C82.94Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb
C82.95Follicular lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C82.96Follicular lymphoma, unspecified, intrapelvic lymph nodes
C82.97Follicular lymphoma, unspecified, spleen
C82.98Follicular lymphoma, unspecified, lymph nodes of multiple sites
C82.99Follicular lymphoma, unspecified, extranodal and solid organ sites
C83.30Diffuse large B-cell lymphoma, unspecified site
C83.31Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck
C83.32Diffuse large B-cell lymphoma, intrathoracic lymph nodes
C83.33Diffuse large B-cell lymphoma, intra-abdominal lymph nodes
C83.34Diffuse large B-cell lymphoma, lymph nodes of axilla and upper limb
C83.35Diffuse large B-cell lymphoma, lymph nodes of inguinal region and lower limb
C83.36Diffuse large B-cell lymphoma, intrapelvic lymph nodes
C83.37Diffuse large B-cell lymphoma, spleen
C83.38Diffuse large B-cell lymphoma, lymph nodes of multiple sites
C83.398Diffuse large B-cell lymphoma of other extranodal and solid organ sites
C83.50Lymphoblastic (diffuse) lymphoma, unspecified site
C83.51Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck
C83.52Lymphoblastic (diffuse) lymphoma, intrathoracic lymph nodes
C83.53Lymphoblastic (diffuse) lymphoma, intra-abdominal lymph nodes
C83.54Lymphoblastic (diffuse) lymphoma, lymph nodes of axilla and upper limb
C83.55Lymphoblastic (diffuse) lymphoma, lymph nodes of inguinal region and lower limb
C83.56Lymphoblastic (diffuse) lymphoma, intrapelvic lymph nodes
C83.57Lymphoblastic (diffuse) lymphoma, spleen
C83.58Lymphoblastic (diffuse) lymphoma, lymph nodes of multiple sites
C83.59Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites
​​C83.80Other non-follicular lymphoma, unspecified site
C83.81Other non-follicular lymphoma, lymph nodes of head, face, and neck
C83.82Other non-follicular lymphoma, intrathoracic lymph nodes
C83.83Other non-follicular lymphoma,​ intra-abdominal lymph nodes​​
C83.84Other non-follicular lymphoma, lymph nodes of axilla and upper limb
C83.85Other non-follicular lymphoma, lymph nodes of inguinal region and lower limb
C83.86Other non-follicular lymphoma,​ intrapelvic lymph nodes
C83.87Other non-follicular lymphoma, spleen
C83.88Other non-follicular lymphoma, lymph nodes of multiple sites
C83.89Other non-follicular lymphoma,​ extranodal and solid organ sites
C83.90Non-follicular (diffuse) lymphoma, unspecified, unspecified site
C83.91Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of head, face, and neck
C83.92Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes
C83.93Non-follicular (diffuse) lymphoma, unspecified, intra-abdominal lymph nodes
C83.94Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of axilla and upper limb
C83.95Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C83.96Non-follicular (diffuse) lymphoma, unspecified, intrapelvic lymph nodes
C83.97Non-follicular (diffuse) lymphoma, unspecified, spleen
C83.98Non-follicular (diffuse) lymphoma, unspecified, lymph nodes of multiple sites
C83.99Non-follicular (diffuse) lymphoma, unspecified, extranodal and solid organ sites​​​
C84.00Mycosis fungoides, unspecified site
C84.01Mycosis fungoides, lymph nodes of head, face, and neck
C84.02Mycosis fungoides, intrathoracic lymph nodes
C84.03Mycosis fungoides, intra-abdominal lymph nodes
C84.04Mycosis fungoides, lymph nodes of axilla and upper limb
C84.05Mycosis fungoides, lymph nodes of inguinal region and lower limb
C84.06Mycosis fungoides, intrapelvic lymph nodes
C84.07Mycosis fungoides, spleen
C84.08Mycosis fungoides, lymph nodes of multiple sites
C84.09Mycosis fungoides, extranodal and solid organ sites
C84.10Sezary disease, unspecified site
C84.11Sezary disease, lymph nodes of head, face, and neck
C84.12Sezary disease, intrathoracic lymph nodes
C84.13Sezary disease, intra-abdominal lymph nodes
C84.14Sezary disease, lymph nodes of axilla and upper limb
C84.15Sezary disease, lymph nodes of inguinal region and lower limb
C84.16Sezary disease, intrapelvic lymph nodes
C84.17Sezary disease, spleen
C84.18Sezary disease, lymph nodes of multiple sites
C84.19Sezary disease, extranodal and solid organ sites
C84.40Peripheral T-cell lymphoma, not elsewhere classified, unspecified site
C84.41Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of head, face, and neck
C84.42Peripheral T-cell lymphoma, not elsewhere classified, intrathoracic lymph nodes
C84.43Peripheral T-cell lymphoma, not elsewhere classified, intra-abdominal lymph nodes
C84.44Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of axilla and upper limb
C84.45Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of inguinal region and lower limb
C84.46Peripheral T-cell lymphoma, not elsewhere classified, intrapelvic lymph nodes
C84.47Peripheral T-cell lymphoma, not elsewhere classified, spleen
C84.48Peripheral T-cell lymphoma, not elsewhere classified, lymph nodes of multiple sites
C84.49Peripheral T-cell lymphoma, not elsewhere classified, extranodal and solid organ sites
C84.60Anaplastic large cell lymphoma, ALK-positive, unspecified site
C84.61Anaplastic large cell lymphoma, ALK-positive, lymph nodes of head, face, and neck
C84.62Anaplastic large cell lymphoma, ALK-positive, intrathoracic lymph nodes
C84.63Anaplastic large cell lymphoma, ALK-positive, intra-abdominal lymph nodes
C84.64Anaplastic large cell lymphoma, ALK-positive, lymph nodes of axilla and upper limb
C84.65Anaplastic large cell lymphoma, ALK-positive, lymph nodes of inguinal region and lower limb
C84.66Anaplastic large cell lymphoma, ALK-positive, intrapelvic lymph nodes
C84.67Anaplastic large cell lymphoma, ALK-positive, spleen
C84.68Anaplastic large cell lymphoma, ALK-positive, lymph nodes of multiple sites
C84.69Anaplastic large cell lymphoma, ALK-positive, extranodal and solid organ sites
C84.70Anaplastic large cell lymphoma, ALK-negative, unspecified site
C84.71Anaplastic large cell lymphoma, ALK-negative, lymph nodes of head, face, and neck
C84.72Anaplastic large cell lymphoma, ALK-negative, intrathoracic lymph nodes
C84.73Anaplastic large cell lymphoma, ALK-negative, intra-abdominal lymph nodes
C84.74Anaplastic large cell lymphoma, ALK-negative, lymph nodes of axilla and upper limb
C84.75Anaplastic large cell lymphoma, ALK-negative, lymph nodes of inguinal region and lower limb
C84.76Anaplastic large cell lymphoma, ALK-negative, intrapelvic lymph nodes
C84.77Anaplastic large cell lymphoma, ALK-negative, spleen
C84.78Anaplastic large cell lymphoma, ALK-negative, lymph nodes of multiple sites
C84.79Anaplastic large cell lymphoma, ALK-negative, extranodal and solid organ sites
C84.7AAnaplastic large cell lymphoma, ALK-negative, breast
​​C84.90Mature T/NK-cell lymphomas, unspecified, unspecified site
C84.91​​Mature T/NK-cell lymphomas, unspecified, lymph nodes of head, face, and neck
C84.92​​Mature T/NK-cell lymphomas, unspecified, intrathoracic lymph nodes
C84.93​​Mature T/NK-cell lymphomas, unspecified, intra-abdominal lymph nodes
C84.94​​Mature T/NK-cell lymphomas, unspecified, lymph nodes of axilla and upper limb
C84.95​​Mature T/NK-cell lymphomas, unspecified, lymph nodes of inguinal region and lower limb
C84.96​​Mature T/NK-cell lymphomas, unspecified, intrapelvic lymph nodes
C84.97​​Mature T/NK-cell lymphomas, unspecified, spleen
C84.98​​Mature T/NK-cell lymphomas, unspecified, lymph nodes of multiple sites
C84.99​​Mature T/NK-cell lymphomas, unspecified,​ extranodal and solid organ sites ​
C84.A0Cutaneous T-cell lymphoma, unspecified, unspecified site
C84.A1Cutaneous T-cell lymphoma, unspecified lymph nodes of head, face, and neck
C84.A2Cutaneous T-cell lymphoma, unspecified, intrathoracic lymph nodes
C84.A3Cutaneous T-cell lymphoma, unspecified, intra-abdominal lymph nodes
C84.A4Cutaneous T-cell lymphoma, unspecified, lymph nodes of axilla and upper limb
C84.A5Cutaneous T-cell lymphoma, unspecified, lymph nodes of inguinal region and lower limb
C84.A6Cutaneous T-cell lymphoma, unspecified, intrapelvic lymph nodes
C84.A7Cutaneous T-cell lymphoma, unspecified, spleen
C84.A8Cutaneous T-cell lymphoma, unspecified, lymph nodes of multiple sites
C84.A9Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ sites
​​C84.Z0Other mature T/NK-cell lymphomas, unspecified site
C84.Z1Other mature T/NK-cell lymphomas, lymph nodes of head, face, and neck
C84.Z2Other mature T/NK-cell lymphomas, intrathoracic lymph nodes
C84.Z3Other mature T/NK-cell lymphomas, intra-abdominal lymph nodes
C84.Z4Other mature T/NK-cell lymphomas, lymph nodes of axilla and upper limb
C84.Z5Other mature T/NK-cell lymphomas, lymph nodes of inguinal region and lower limb
C84.Z6Other mature T/NK-cell lymphomas, intrapelvic lymph nodes
C84.Z7Other mature T/NK-cell lymphomas,​ spleen​
C84.Z8Other mature T/NK-cell lymphomas, lymph nodes of multiple sites
C84.Z9Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C85.10Unspecified B-cell lymphoma, unspecified site
C85.11Unspecified B-cell lymphoma, lymph nodes of head, face, and neck
C85.12Unspecified B-cell lymphoma, intrathoracic lymph nodes
C85.13Unspecified B-cell lymphoma, intra-abdominal lymph nodes
C85.14Unspecified B-cell lymphoma, lymph nodes of axilla and upper limb
C85.15Unspecified B-cell lymphoma, lymph nodes of inguinal region and lower limb
C85.16Unspecified B-cell lymphoma, intrapelvic lymph nodes
C85.17Unspecified B-cell lymphoma, spleen
C85.18Unspecified B-cell lymphoma, lymph nodes of multiple sites
C85.19Unspecified B-cell lymphoma, extranodal and solid organ sites
​​C85.20Mediastinal (thymic) large B-cell lymphoma, unspecified site
C85.21Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck
C85.22Mediastinal (thymic) large B-cell lymphoma,​ intrathoracic lymph nodes
C85.23Mediastinal (thymic) large B-cell lymphoma,​ intra-abdominal lymph nodes
C85.24Mediastinal (thymic) large B-cell lymphoma, lymph nodes of axilla and upper limb
C85.25Mediastinal (thymic) large B-cell lymphoma, lymph nodes of inguinal region and lower limb
C85.26Mediastinal (thymic) large B-cell lymphoma, intrapelvic lymph nodes
C85.27Mediastinal (thymic) large B-cell lymphoma, spleen
C85.28Mediastinal (thymic) large B-cell lymphoma, lymph nodes of multiple sites
C85.29Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ sites
C85.80Other specified types of non-Hodgkin lymphoma, unspecified site
C85.81Other specified types of non-Hodgkin lymphoma, lymph nodes of head, face, and neck
C85.82Other specified types of non-Hodgkin lymphoma, intrathoracic lymph nodes
C85.83Other specified types of non-Hodgkin lymphoma, intrathoracic lymph nodes
C85.84Other specified types of non-Hodgkin lymphoma, lymph nodes of axilla and upper limb
C85.85Other specified types of non-Hodgkin lymphoma, lymph nodes of inguinal region and lower limb
C85.86Other specified types of non-Hodgkin lymphoma, intrapelvic lymph nodes
C85.87Other specified types of non-Hodgkin lymphoma, spleen
C85.88Other specified types of non-Hodgkin lymphoma, lymph nodes of multiple sites
C85.89Other specified types of non-Hodgkin lymphoma,​ extranodal and solid organ sites​​
C86.00 Extranodal NK/T-cell lymphoma, nasal type not having achieved remission
C86.10 Hepatosplenic T-cell lymphoma not having achieved remission
C86.20Enteropathy-type (intestinal) T-cell lymphoma not having achieved remission
C86.50Angioimmunoblastic T-cell lymphoma not having achieved remission
C86.60Primary cutaneous CD30-positive T-cell proliferations not having achieved remission
C91.50Adult T-cell lymphoma/leukemia (HTLV-1-associated) not having achieved remission
C91.51Adult T-cell lymphoma/leukemia (HTLV-1-associated), in remission  
C91.52Adult T-cell lymphoma/leukemia (HTLV-1-associated), in relapse
D47.Z1Post -transplant lymphoproliferative disorder (PTLD)​



11/18/2024
11/18/2024
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Medical Policy Bulletin
Medicare Advantage
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