Z85.46: Personal history of malignant neoplasm of prostate

Z85.46, personal history of malignant neoplasm of prostate, is listed as a covered diagnosis in 7 Medicare billing and coding articles that apply to 44 HCPCS Level II codes, including J9217 (Leuprolide acetate (for depot suspension), 7.5 mg), J1952 (Leuprolide injectable, camcevi, 1 mg), J3315 (Injection, triptorelin pamoate, 3.75 mg). 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 Z85.46 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
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
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
J1740Injection, ibandronate sodium, 1 mgCarrier judgment—1
J2430Injection, pamidronate disodium, per 30 mgSpecial coverage instructions apply—1
J0897Injection, denosumab, 1 mgCarrier judgment—1
Q5136Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mgCarrier judgment—1
Q5157Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mgCarrier judgment—1
Q5158Injection, denosumab-bnht (bomyntra/conexxence), biosimilar, 1 mgCarrier judgment—1
Q5159Injection, denosumab-dssb (ospomyv/xbryk), biosimilar, 1 mgCarrier judgment—1
Q5162Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mgCarrier judgment—1
Q5165Injection, denosumab-mobz (oziltus), biosimilar, 1 mgCarrier judgment—1
Q5166Injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mgCarrier judgment—1
Q5167Injection, denosumab-qbde (enoby/xtrenbo), biosimilar, 1 mgCarrier judgment—1
Q5171Injection, denosumab-mobz (boncresa), biosimilar, 1 mgCarrier judgment—1
Q5129Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mgCarrier judgment—1
Q5126Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mgCarrier judgment—1

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

Medicare policy articles listing Z85.46

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 Z85.46 (Personal history of malignant neoplasm of prostate)?

Medicare covers items and services, not diagnoses. 7 Medicare billing and coding articles list Z85.46 as a covered diagnosis for 44 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 Z85.46?

The Level II codes from the policies most specific to this diagnosis are J9217 (Leuprolide acetate (for depot suspension), 7.5 mg, 2 articles); J1952 (Leuprolide injectable, camcevi, 1 mg, 2 articles); J3315 (Injection, triptorelin pamoate, 3.75 mg, 2 articles); J1954 (Injection, leuprolide acetate for depot suspension…, 2 articles); J9202 (Goserelin acetate implant, per 3.6 mg, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

Which Medicare policy articles list Z85.46?

A59160 (Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs); A52453 (Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs); A56907 (Billing and Coding: Bisphosphonate Drug Therapy), and 4 more articles.

What is ICD-10-CM code Z85.46?

Z85.46 is the ICD-10-CM code for personal history of malignant neoplasm of prostate, 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