C4A.9: Merkel cell carcinoma, unspecified
C4A.9, merkel cell carcinoma, unspecified, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 29 HCPCS Level II codes, including J0461 (Injection, atropine sulfate, 0.01 mg), J0153 (Injection, adenosine, 1 mg (not to be used to report any…), J1250 (Injection, dobutamine hydrochloride, per 250 mg). 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.9 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J0461 | Injection, atropine sulfate, 0.01 mg | Special coverage instructions apply | — | 1 |
| J0153 | Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) | Special coverage instructions apply | — | 1 |
| J1250 | Injection, dobutamine hydrochloride, per 250 mg | Special coverage instructions apply | — | 1 |
| J0280 | Injection, aminophyllin, up to 250 mg | Special coverage instructions apply | — | 1 |
| J1245 | Injection, dipyridamole, per 10 mg | Special coverage instructions apply | — | 1 |
| J8999 | Prescription drug, oral, chemotherapeutic, nos | Special coverage instructions apply | — | 1 |
| Q0512 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period | Special coverage instructions apply | — | 1 |
| Q0511 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period | Special coverage instructions apply | — | 1 |
| J8530 | Cyclophosphamide; oral, 25 mg | Special coverage instructions apply | — | 1 |
| J8597 | Antiemetic drug, oral, not otherwise specified | Special coverage instructions apply | — | 1 |
| J8610 | Methotrexate; oral, 2.5 mg | Special coverage instructions apply | — | 1 |
| J8498 | Antiemetic drug, rectal/suppository, not otherwise specified | Special coverage instructions apply | — | 1 |
| Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram | Special coverage instructions apply | — | 1 |
| Q5125 | Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram | Carrier judgment | — | 1 |
| Q5101 | Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram | Special coverage instructions apply | — | 1 |
| J1442 | Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram | Special coverage instructions apply | — | 1 |
| J1449 | Injection, eflapegrastim-xnst, 0.1 mg | Carrier judgment | — | 1 |
| J1447 | Injection, tbo-filgrastim, 1 microgram | Special coverage instructions apply | — | 1 |
| Q5108 | Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| Q5111 | Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| Q5127 | Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| Q5122 | Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| Q5130 | Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg | Carrier judgment | — | 1 |
| J2820 | Injection, sargramostim (gm-csf), 50 mcg | Special coverage instructions apply | — | 1 |
4 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing C4A.9
- A54768: Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy (Palmetto GBA (MAC - Part A, MAC - Part B); 5 Level II codes)
- A52479: Oral Anticancer Drugs - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 8 Level II codes). LCD with the same title: L33826
- A56748: Billing and Coding: White Cell Colony Stimulating Factors (Palmetto GBA (MAC - Part A, MAC - Part B); 16 Level II codes). LCD with the same title: L37176
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)
- C4A.0 — Merkel cell carcinoma of lip
- C4A.111 — Merkel cell carcinoma of right upper eyelid, including canthus
- C4A.112 — Merkel cell carcinoma of right lower eyelid, including canthus
- C4A.121 — Merkel cell carcinoma of left upper eyelid, including canthus
- C4A.122 — Merkel cell carcinoma of left lower eyelid, including canthus
- C4A.21 — Merkel cell carcinoma of right ear and external auricular canal
- C4A.22 — Merkel cell carcinoma of left ear and external auricular canal
- C4A.30 — Merkel cell carcinoma of unspecified part of face
- C4A.31 — Merkel cell carcinoma of nose
- C4A.39 — Merkel cell carcinoma of other parts of face
- C4A.4 — Merkel cell carcinoma of scalp and neck
- C4A.51 — Merkel cell carcinoma of anal skin
- C4A.52 — Merkel cell carcinoma of skin of breast
- C4A.59 — Merkel cell carcinoma of other part of trunk
- C4A.61 — Merkel cell carcinoma of right upper limb, including shoulder
- C4A.62 — Merkel cell carcinoma of left upper limb, including shoulder
- C4A.71 — Merkel cell carcinoma of right lower limb, including hip
- C4A.72 — Merkel cell carcinoma of left lower limb, including hip
- C4A.8 — Merkel cell carcinoma of overlapping sites
Frequently asked questions
Does Medicare cover C4A.9 (Merkel cell carcinoma, unspecified)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list C4A.9 as a covered diagnosis for 29 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.9?
The Level II codes from the policies most specific to this diagnosis are J0461 (Injection, atropine sulfate, 0.01 mg, 1 article); J0153 (Injection, adenosine, 1 mg (not to be used to report any…, 1 article); J1250 (Injection, dobutamine hydrochloride, per 250 mg, 1 article); J0280 (Injection, aminophyllin, up to 250 mg, 1 article); J1245 (Injection, dipyridamole, per 10 mg, 1 article). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list C4A.9?
A54768 (Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy); A52479 (Oral Anticancer Drugs - Policy Article); A56748 (Billing and Coding: White Cell Colony Stimulating Factors).
What is ICD-10-CM code C4A.9?
C4A.9 is the ICD-10-CM code for merkel cell carcinoma, unspecified, in category C4A (Merkel cell carcinoma), chapter 2: Neoplasms.
Next steps
- Run a reimbursement report for a device billed under J0461
- Watch J0461 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0461
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.