D49.81: Neoplasm of unspecified behavior of retina and choroid
D49.81, neoplasm of unspecified behavior of retina and choroid, is listed as a covered diagnosis in 6 Medicare billing and coding articles that apply to 52 HCPCS Level II codes, including J0881 (Injection, darbepoetin alfa, 1 microgram (non-esrd use)), J0885 (Injection, epoetin alfa, (for non-esrd use), 1000 units), Q5106 (Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for…). 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 D49.81 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| 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 |
| 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 |
| Q9957 | Injection, perflutren lipid microspheres, per ml | Carrier judgment | — | 1 |
| Q9956 | Injection, octafluoropropane microspheres, per ml | Carrier judgment | — | 1 |
| C8925 | Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, real time with image documentation (2d) (with or without m-mode recording); including probe placement, image acquisition, interpretation and report | Special coverage instructions apply | — | 1 |
| C8926 | Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and report | Special coverage instructions apply | — | 1 |
| C8927 | Transesophageal echocardiography (tee) with contrast, or without contrast followed by with contrast, for monitoring purposes, including probe placement, real time 2-dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically changing) cardiac pumping function and to therapeutic measures on an immediate time basis | Special coverage instructions apply | — | 1 |
| Q9955 | Injection, perflexane lipid microspheres, per ml | Carrier judgment | — | 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 |
| 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 |
| J8655 | Netupitant 300 mg and palonosetron 0.5 mg, oral | Special coverage instructions apply | — | 1 |
| J8670 | Rolapitant, oral, 1 mg | Special coverage instructions apply | — | 1 |
27 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing D49.81
- A56505: Billing and Coding: Transesophageal Echocardiography (TEE) (Novitas Solutions, Inc. (MAC - Part A, MAC - Part B); 6 Level II codes). LCD with the same title: L33579, L34337, L35016
- 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
- A56775: Billing and Coding: Magnetic Resonance Angiography (Palmetto GBA (MAC - Part A, MAC - Part B); 18 Level II codes). LCD with the same title: L34424
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 D49 diagnoses (Neoplasms of unspecified behavior)
- D49.89 — Neoplasm of unspecified behavior of other specified sites
- D49.0 — Neoplasm of unspecified behavior of digestive system
- D49.1 — Neoplasm of unspecified behavior of respiratory system
- D49.2 — Neoplasm of unspecified behavior of bone, soft tissue, and skin
- D49.3 — Neoplasm of unspecified behavior of breast
- D49.4 — Neoplasm of unspecified behavior of bladder
- D49.511 — Neoplasm of unspecified behavior of right kidney
- D49.512 — Neoplasm of unspecified behavior of left kidney
- D49.519 — Neoplasm of unspecified behavior of unspecified kidney
- D49.59 — Neoplasm of unspecified behavior of other genitourinary organ
- D49.6 — Neoplasm of unspecified behavior of brain
- D49.7 — Neoplasm of unspecified behavior of endocrine glands and other parts…
Frequently asked questions
Does Medicare cover D49.81 (Neoplasm of unspecified behavior of retina and choroid)?
Medicare covers items and services, not diagnoses. 6 Medicare billing and coding articles list D49.81 as a covered diagnosis for 52 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 D49.81?
The Level II codes from the policies most specific to this diagnosis are J0881 (Injection, darbepoetin alfa, 1 microgram (non-esrd use), 3 articles); J0885 (Injection, epoetin alfa, (for non-esrd use), 1000 units, 3 articles); Q5106 (Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for…, 3 articles); J0882 (Injection, darbepoetin alfa, 1 microgram (for esrd on…, 3 articles); Q5105 (Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for…, 3 articles). Code choice depends on the item supplied; check each code's descriptor.
Which Medicare policy articles list D49.81?
A56505 (Billing and Coding: Transesophageal Echocardiography (TEE)); A58982 (Billing and Coding: Erythropoiesis Stimulating Agents); A56462 (Billing and Coding: Erythropoiesis Stimulating Agents (ESA)), and 3 more articles.
What is ICD-10-CM code D49.81?
D49.81 is the ICD-10-CM code for neoplasm of unspecified behavior of retina and choroid, in category D49 (Neoplasms of unspecified behavior), chapter 2: Neoplasms.
Next steps
- Run a reimbursement report for a device billed under J0881
- Watch J0881 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J0881
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.