C7A.00: Malignant carcinoid tumor of unspecified site

C7A.00, malignant carcinoid tumor of unspecified site, is listed as a covered diagnosis in 5 Medicare billing and coding articles that apply to 53 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…), G0105 (Colorectal cancer screening; colonoscopy on individual at…). 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 C7A.00 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
G0105Colorectal cancer screening; colonoscopy on individual at high riskSpecial coverage instructions apply—1
G9998Documentation of medical reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., last colonoscopy incomplete, last colonoscopy had inadequate prep, piecemeal removal of adenomas, or sessile serrated polyps >= 20 mm in size, last colonoscopy found greater than 10 adenomas, lower gastrointestinal bleeding, or patient at high risk for colon cancer due to underlying medical history ([i.e. crohn's disease, ulcerative colitis, personal or family history of colon cancer, hereditary colorectal cancer syndromes])Carrier judgment—1
G9999Documentation of system reason(s) for an interval of less than 3 years since the last colonoscopy (e.g., unable to locate previous colonoscopy report, patient cannot provide precise date or details from previous colonoscopy, previous colonoscopy report was incomplete)Carrier judgment—1
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

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

Medicare policy articles listing C7A.00

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 C7A diagnoses (Malignant neuroendocrine tumors)

Frequently asked questions

Does Medicare cover C7A.00 (Malignant carcinoid tumor of unspecified site)?

Medicare covers items and services, not diagnoses. 5 Medicare billing and coding articles list C7A.00 as a covered diagnosis for 53 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 C7A.00?

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); G0105 (Colorectal cancer screening; colonoscopy on individual at…, 1 article); G9998 (Documentation of medical reason(s) for an interval of less…, 1 article); G9999 (Documentation of system reason(s) for an interval of less…, 1 article). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list C7A.00?

A56632 (Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy); A52479 (Oral Anticancer Drugs - Policy Article); A56748 (Billing and Coding: White Cell Colony Stimulating Factors), and 2 more articles.

What is ICD-10-CM code C7A.00?

C7A.00 is the ICD-10-CM code for malignant carcinoid tumor of unspecified site, in category C7A (Malignant neuroendocrine tumors), 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