C61: Malignant neoplasm of prostate

C61, malignant neoplasm of prostate, is listed as a covered diagnosis in 19 Medicare billing and coding articles that apply to 104 HCPCS Level II codes, including A9606 (Radium ra-223 dichloride, therapeutic, per microcurie), Q2043 (Sipuleucel-t, minimum of 50 million autologous cd54+ cells…), J9217 (Leuprolide acetate (for depot suspension), 7.5 mg). 4 of these codes have a 2026 DMEPOS fee schedule amount; E0783 pays $9,917.33 to $11,667.45 (NU) depending on the state. The articles come from 5 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 C61 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
A9606Radium ra-223 dichloride, therapeutic, per microcurieCarrier judgment—1
Q2043Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusionSpecial coverage instructions apply—1
J9217Leuprolide acetate (for depot suspension), 7.5 mgSpecial coverage instructions apply—2
J1952Leuprolide injectable, camcevi, 1 mgCarrier judgment—2
J3315Injection, triptorelin pamoate, 3.75 mgSpecial coverage instructions apply—2
J1954Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mgCarrier judgment—2
J9202Goserelin acetate implant, per 3.6 mgSpecial coverage instructions apply—2
J1950Injection, leuprolide acetate (for depot suspension), per 3.75 mgSpecial coverage instructions apply—2
J9219Leuprolide acetate implant, 65 mgSpecial coverage instructions apply—2
J9225Histrelin implant (vantas), 50 mgSpecial coverage instructions apply—2
G0340Image-guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum five sessions per course of treatmentCarrier judgment—2
G0339Image-guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatmentCarrier judgment—2
J0881Injection, darbepoetin alfa, 1 microgram (non-esrd use)Special coverage instructions apply—3
J0885Injection, epoetin alfa, (for non-esrd use), 1000 unitsSpecial coverage instructions apply—3
Q5106Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 unitsSpecial coverage instructions apply—3
J0882Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis)Special coverage instructions apply—3
Q5105Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 unitsSpecial coverage instructions apply—3
J0890Injection, peginesatide, 0.1 mg (for esrd on dialysis)Carrier judgment—3
Q4081Injection, epoetin alfa, 100 units (for esrd on dialysis)Special coverage instructions apply—3
J3316Injection, triptorelin, extended-release, 3.75 mgSpecial coverage instructions apply—1
J9218Leuprolide acetate, per 1 mgSpecial coverage instructions apply—1
J3489Injection, zoledronic acid, 1 mgCarrier judgment—1
J1740Injection, ibandronate sodium, 1 mgCarrier judgment—1
J2430Injection, pamidronate disodium, per 30 mgSpecial coverage instructions apply—1
G0563Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real-time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractionsCarrier judgment—1

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

Medicare policy articles listing C61

4 more articles list C61.

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.

Frequently asked questions

Does Medicare cover C61 (Malignant neoplasm of prostate)?

Medicare covers items and services, not diagnoses. 19 Medicare billing and coding articles list C61 as a covered diagnosis for 104 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 C61?

The Level II codes from the policies most specific to this diagnosis are A9606 (Radium ra-223 dichloride, therapeutic, per microcurie, 1 article); Q2043 (Sipuleucel-t, minimum of 50 million autologous cd54+ cells…, 1 article); J9217 (Leuprolide acetate (for depot suspension), 7.5 mg, 2 articles); J1952 (Leuprolide injectable, camcevi, 1 mg, 2 articles); J3315 (Injection, triptorelin pamoate, 3.75 mg, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with C61?

Under the 2026 DMEPOS fee schedule (non-rural state fees): E0783 $9,917.33 to $11,667.45 (NU); E0786 $10,969.75 to $11,380.88 (NU); E0782 $5,200.92 to $6,118.73 (NU); E0785 $572.38 to $673.39 (KF). Medicare pays 80% of the allowed amount after the Part B deductible.

Which Medicare policy articles list C61?

A54559 (Billing and Coding: Xofigo Billing Instructions); A55719 (Sipuleucel-T (Provenge®) - Coverage Criteria for Prostate Cancer – Clarification); A59160 (Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs), and 16 more articles.

What is ICD-10-CM code C61?

C61 is the ICD-10-CM code for malignant neoplasm of prostate, in category C61 (Malignant neoplasm of prostate), 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