Z85.3: Personal history of malignant neoplasm of breast

Z85.3, personal history of malignant neoplasm of breast, is listed as a covered diagnosis in 13 Medicare billing and coding articles that apply to 60 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). 6 of these codes have a 2026 DMEPOS fee schedule amount; L8035 pays $4,403.11 to $5,283.69 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 Z85.3 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
C8903Magnetic resonance imaging with contrast, breast; unilateralSpecial coverage instructions apply—2
C8905Magnetic resonance imaging without contrast followed by with contrast, breast; unilateralSpecial coverage instructions apply—2
C8906Magnetic resonance imaging with contrast, breast; bilateralSpecial coverage instructions apply—2
C8908Magnetic resonance imaging without contrast followed by with contrast, breast; bilateralSpecial coverage instructions apply—2
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
L8035Custom breast prosthesis, post mastectomy, molded to patient model, any typeSpecial coverage instructions apply$4,403.11–$5,283.691
L8002Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any typeSpecial coverage instructions apply$198.27–$218.121
L8001Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any typeSpecial coverage instructions apply$150.77–$165.831
L8015External breast prosthesis garment, with mastectomy form, post mastectomySpecial coverage instructions apply$72.05–$86.411
L8000Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any typeSpecial coverage instructions apply$44.70–$78.161
A4280Adhesive skin support attachment for use with external breast prosthesis, eachCarrier judgment$7.38–$8.131
Q2028Injection, sculptra, 0.5 mgSpecial coverage instructions apply—2
G0429Dermal filler injection(s) for the treatment of facial lipodystrophy syndrome (lds) (e.g., as a result of highly active antiretroviral therapy)Carrier judgment—2
Q2026Injection, radiesse, 0.1 mlSpecial coverage instructions apply—2
G0279Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)Carrier judgment—1
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

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

Medicare policy articles listing Z85.3

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 Z85 diagnoses (Personal history of malignant neoplasm)

Frequently asked questions

Does Medicare cover Z85.3 (Personal history of malignant neoplasm of breast)?

Medicare covers items and services, not diagnoses. 13 Medicare billing and coding articles list Z85.3 as a covered diagnosis for 60 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 Z85.3?

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); J9217 (Leuprolide acetate (for depot suspension), 7.5 mg, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with Z85.3?

Under the 2026 DMEPOS fee schedule (non-rural state fees): L8035 $4,403.11 to $5,283.69; L8002 $198.27 to $218.12; L8001 $150.77 to $165.83; L8015 $72.05 to $86.41. Medicare pays 80% of the allowed amount after the Part B deductible.

Which Medicare policy articles list Z85.3?

A52478 (External Breast Prostheses - Policy Article); 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), and 10 more articles.

What is ICD-10-CM code Z85.3?

Z85.3 is the ICD-10-CM code for personal history of malignant neoplasm of breast, in category Z85 (Personal history of malignant neoplasm), chapter 22: Factors influencing health status and contact with health services.

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 22: Factors influencing health status and contact with health services · All diagnoses · HCPCS lookup