C4A.30: Merkel cell carcinoma of unspecified part of face

C4A.30, merkel cell carcinoma of unspecified part of face, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 41 HCPCS Level II codes, including Q0512 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…), Q0511 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…), J8999 (Prescription drug, oral, chemotherapeutic, nos). The articles come from 2 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.

HCPCS Level II codes with C4A.30 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
Q0512Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day periodSpecial coverage instructions apply—2
Q0511Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day periodSpecial coverage instructions apply—2
J8999Prescription drug, oral, chemotherapeutic, nosSpecial coverage instructions apply—1
J8530Cyclophosphamide; oral, 25 mgSpecial coverage instructions apply—1
J8597Antiemetic drug, oral, not otherwise specifiedSpecial coverage instructions apply—1
J8610Methotrexate; oral, 2.5 mgSpecial coverage instructions apply—1
J8498Antiemetic drug, rectal/suppository, not otherwise specifiedSpecial coverage instructions apply—1
Q5110Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgramSpecial coverage instructions apply—1
Q5125Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgramCarrier judgment—1
Q5101Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgramSpecial coverage instructions apply—1
J1442Injection, filgrastim (g-csf), excludes biosimilars, 1 microgramSpecial coverage instructions apply—1
J1449Injection, eflapegrastim-xnst, 0.1 mgCarrier judgment—1
J1447Injection, tbo-filgrastim, 1 microgramSpecial coverage instructions apply—1
Q5108Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mgCarrier judgment—1
Q5111Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mgCarrier judgment—1
Q5127Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mgCarrier judgment—1
J2506Injection, pegfilgrastim, excludes biosimilar, 0.5 mgCarrier judgment—1
Q5122Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mgCarrier judgment—1
Q5130Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mgCarrier judgment—1
J2820Injection, sargramostim (gm-csf), 50 mcgSpecial coverage instructions apply—1
Q5120Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mgCarrier judgment—1
Q5148Injection, filgrastim-txid (nypozi), biosimilar, 1 microgramSpecial coverage instructions apply—1
Q5169Injection, pegfilgrastim-unne (armlupeg), biosimilar, 0.5 mgCarrier judgment—1
Q0162Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimenSpecial coverage instructions apply—1
J8540Dexamethasone, oral, 0.25 mgSpecial coverage instructions apply—1

16 more codes are listed. See every code with payment by region in Caduvo.

Medicare policy articles listing C4A.30

A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.

Other C4A diagnoses (Merkel cell carcinoma)

Frequently asked questions

Does Medicare cover C4A.30 (Merkel cell carcinoma of unspecified part of face)?

Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list C4A.30 as a covered diagnosis for 41 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.

Which HCPCS codes can be billed with ICD-10 C4A.30?

The Level II codes from the policies most specific to this diagnosis are Q0512 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…, 2 articles); Q0511 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…, 2 articles); J8999 (Prescription drug, oral, chemotherapeutic, nos, 1 article); J8530 (Cyclophosphamide; oral, 25 mg, 1 article); J8597 (Antiemetic drug, oral, not otherwise specified, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list C4A.30?

A52479 (Oral Anticancer Drugs - Policy Article); A56748 (Billing and Coding: White Cell Colony Stimulating Factors); A52480 (Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article).

What is ICD-10-CM code C4A.30?

C4A.30 is the ICD-10-CM code for merkel cell carcinoma of unspecified part of face, in category C4A (Merkel cell carcinoma), chapter 2: Neoplasms.

Next steps

Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.

Chapter 2: Neoplasms · All diagnoses · HCPCS lookup