D13.1: Benign neoplasm of stomach
D13.1, benign neoplasm of stomach, is listed as a covered diagnosis in 3 Medicare billing and coding articles that apply to 18 HCPCS Level II codes, including J0585 (Injection, onabotulinumtoxina, 1 unit), J8999 (Prescription drug, oral, chemotherapeutic, nos), Q0512 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…). 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 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 D13.1 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J0585 | Injection, onabotulinumtoxina, 1 unit | 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 |
| E0783 | Infusion pump system, implantable, programmable (includes all components, e.g., pump, catheter, connectors, etc.) | Special coverage instructions apply | $9,917.33–$11,667.45 (NU) | 1 |
| E0786 | Implantable programmable infusion pump, replacement (excludes implantable intraspinal catheter) | Special coverage instructions apply | $10,969.75–$11,380.88 (NU) | 1 |
| E0782 | Infusion pump, implantable, non-programmable (includes all components, e.g., pump, catheter, connectors, etc.) | Special coverage instructions apply | $5,200.92–$6,118.73 (NU) | 1 |
| E0785 | Implantable intraspinal (epidural/intrathecal) catheter used with implantable infusion pump, replacement | Special coverage instructions apply | $572.38–$673.39 (KF) | 1 |
| J7999 | Compounded drug, not otherwise classified | Special coverage instructions apply | — | 1 |
| J2278 | Injection, ziconotide, 1 microgram | Special coverage instructions apply | — | 1 |
| J2274 | Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg | Special coverage instructions apply | — | 1 |
| A4220 | Refill kit for implantable infusion pump | Special coverage instructions apply | — | 1 |
| J9200 | Injection, floxuridine, 500 mg | Special coverage instructions apply | — | 1 |
| A9270 | Non-covered item or service | Non-covered by Medicare | Not covered | 1 |
Medicare policy articles listing D13.1
- A56389: Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization (Palmetto GBA (MAC - Part A, MAC - Part B); 1 Level II codes). LCD with the same title: L34434
- 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
- A56695: Billing and Coding: Implantable Infusion Pump (Palmetto GBA (MAC - Part B); 9 Level II codes). LCD with the same title: L33461
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 D13 diagnoses (Benign neoplasm of other and ill-defined parts of digestive system)
- D13.2 — Benign neoplasm of duodenum
- D13.39 — Benign neoplasm of other parts of small intestine
- D13.7 — Benign neoplasm of endocrine pancreas
Frequently asked questions
Does Medicare cover D13.1 (Benign neoplasm of stomach)?
Medicare covers items and services, not diagnoses. 3 Medicare billing and coding articles list D13.1 as a covered diagnosis for 18 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 D13.1?
The Level II codes from the policies most specific to this diagnosis are J0585 (Injection, onabotulinumtoxina, 1 unit, 1 article); J8999 (Prescription drug, oral, chemotherapeutic, nos, 1 article); Q0512 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…, 1 article); Q0511 (Pharmacy supply fee for oral anti-cancer, oral anti-emetic…, 1 article); J8530 (Cyclophosphamide; oral, 25 mg, 1 article). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with D13.1?
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 D13.1?
A56389 (Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization); A52479 (Oral Anticancer Drugs - Policy Article); A56695 (Billing and Coding: Implantable Infusion Pump).
What is ICD-10-CM code D13.1?
D13.1 is the ICD-10-CM code for benign neoplasm of stomach, in category D13 (Benign neoplasm of other and ill-defined parts of digestive system), chapter 2: Neoplasms.
Next steps
- Run a reimbursement report for a device billed under J0585
- Watch J0585 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0585
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.