D48.61: Neoplasm of uncertain behavior of right breast
D48.61, neoplasm of uncertain behavior of right breast, is listed as a covered diagnosis in 9 Medicare billing and coding articles that apply to 45 HCPCS Level II codes, including C8903 (Magnetic resonance imaging with contrast, breast; unilateral), C8905 (Magnetic resonance imaging without contrast followed by…), C8906 (Magnetic resonance imaging with contrast, breast; bilateral). 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 4 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 D48.61 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| C8903 | Magnetic resonance imaging with contrast, breast; unilateral | Special coverage instructions apply | — | 2 |
| C8905 | Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral | Special coverage instructions apply | — | 2 |
| C8906 | Magnetic resonance imaging with contrast, breast; bilateral | Special coverage instructions apply | — | 2 |
| C8908 | Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral | Special coverage instructions apply | — | 2 |
| Q2028 | Injection, sculptra, 0.5 mg | Special coverage instructions apply | — | 2 |
| G0429 | Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy) | Carrier judgment | — | 2 |
| Q2026 | Injection, radiesse, 0.1 ml | Special coverage instructions apply | — | 2 |
| J0881 | Injection, darbepoetin alfa, 1 microgram (non-esrd use) | Special coverage instructions apply | — | 3 |
| J0885 | Injection, epoetin alfa, (for non-esrd use), 1000 units | Special coverage instructions apply | — | 3 |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | Special coverage instructions apply | — | 3 |
| J0882 | Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) | Special coverage instructions apply | — | 3 |
| Q5105 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units | Special coverage instructions apply | — | 3 |
| J0890 | Injection, peginesatide, 0.1 mg (for esrd on dialysis) | Carrier judgment | — | 3 |
| Q4081 | Injection, epoetin alfa, 100 units (for esrd on dialysis) | Special coverage instructions apply | — | 3 |
| G0279 | Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) | Carrier judgment | — | 1 |
| J0888 | Injection, epoetin beta, 1 microgram, (for non esrd use) | Special coverage instructions apply | — | 2 |
| J0887 | Injection, epoetin beta, 1 microgram, (for esrd on dialysis) | Special coverage instructions apply | — | 2 |
| 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 |
| Q0162 | Ondansetron 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 regimen | Special coverage instructions apply | — | 1 |
| J8540 | Dexamethasone, oral, 0.25 mg | Special coverage instructions apply | — | 1 |
| Q0166 | Granisetron hydrochloride, 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 24 hour dosage regimen | Special coverage instructions apply | — | 1 |
| J8501 | Aprepitant, oral, 5 mg | Special coverage instructions apply | — | 1 |
| Q0164 | Prochlorperazine maleate, 5 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 regimen | Special coverage instructions apply | — | 1 |
| Q0163 | Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen | Special coverage instructions apply | — | 1 |
20 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing D48.61
- A52849: Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography (Wellpoint Federal (MAC - Part A, MAC - Part B); 4 Level II codes). LCD with the same title: L33585
- A56448: Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 5 Level II codes). LCD with the same title: L33950
- A59299: Billing and Coding: Cosmetic and Reconstructive Surgery (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L33428, L35090, L38914, L39051
- A58774: Billing and Coding: Cosmetic and Reconstructive Surgery (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L33428, L35090, L38914, L39051
- A58982: Billing and Coding: Erythropoiesis Stimulating Agents (Palmetto GBA (MAC - Part A, MAC - Part B); 9 Level II codes). LCD with the same title: L39237
- A56462: Billing and Coding: Erythropoiesis Stimulating Agents (ESA) (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 7 Level II codes). LCD with the same title: L34356
- A52480: Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 19 Level II codes). LCD with the same title: L33827
- A60381: Billing and Coding: Erythropoiesis Stimulating Agents (Wellpoint Federal (MAC - Part A, MAC - Part B); 9 Level II codes). LCD with the same title: L39237
- 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 D48 diagnoses (Neoplasm of uncertain behavior of other and unspecified sites)
- D48.62 — Neoplasm of uncertain behavior of left breast
- D48.0 — Neoplasm of uncertain behavior of bone and articular cartilage
- D48.110 — Desmoid tumor of head and neck
- D48.111 — Desmoid tumor of chest wall
- D48.112 — Desmoid tumor, intrathoracic
- D48.113 — Desmoid tumor of abdominal wall
- D48.114 — Desmoid tumor, intraabdominal
- D48.115 — Desmoid tumor of upper extremity and shoulder girdle
- D48.116 — Desmoid tumor of lower extremity and pelvic girdle
- D48.117 — Desmoid tumor of back
- D48.118 — Desmoid tumor of other site
- D48.119 — Desmoid tumor of unspecified site
- D48.19 — Other specified neoplasm of uncertain behavior of connective and…
- D48.2 — Neoplasm of uncertain behavior of peripheral nerves and autonomic…
- D48.3 — Neoplasm of uncertain behavior of retroperitoneum
- D48.4 — Neoplasm of uncertain behavior of peritoneum
- D48.5 — Neoplasm of uncertain behavior of skin
- D48.7 — Neoplasm of uncertain behavior of other specified sites
- D48.9 — Neoplasm of uncertain behavior, unspecified
Frequently asked questions
Does Medicare cover D48.61 (Neoplasm of uncertain behavior of right breast)?
Medicare covers items and services, not diagnoses. 9 Medicare billing and coding articles list D48.61 as a covered diagnosis for 45 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 D48.61?
The Level II codes from the policies most specific to this diagnosis are C8903 (Magnetic resonance imaging with contrast, breast; unilateral, 2 articles); C8905 (Magnetic resonance imaging without contrast followed by…, 2 articles); C8906 (Magnetic resonance imaging with contrast, breast; bilateral, 2 articles); C8908 (Magnetic resonance imaging without contrast followed by…, 2 articles); Q2028 (Injection, sculptra, 0.5 mg, 2 articles). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with D48.61?
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 D48.61?
A52849 (Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography); A56448 (Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography); A59299 (Billing and Coding: Cosmetic and Reconstructive Surgery), and 6 more articles.
What is ICD-10-CM code D48.61?
D48.61 is the ICD-10-CM code for neoplasm of uncertain behavior of right breast, in category D48 (Neoplasm of uncertain behavior of other and unspecified sites), chapter 2: Neoplasms.
Next steps
- Run a reimbursement report for a device billed under C8903
- Watch C8903 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for C8903
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.