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1 Local Coverage Determination (LCD): Flow Cytometry (L34215) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor Name Contract Type Contract Number Jurisdiction State(s) Noridian Healthcare Solutions, LLC A and B MAC MAC A J - E California - Entire State Noridian Healthcare Solutions, LLC A and B MAC MAC B J - E California - Northern Noridian Healthcare Solutions, LLC A and B MAC MAC B J - E California - Southern Noridian Healthcare Solutions, LLC A and B MAC MAC A J - E American Samoa Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, LLC A and B MAC MAC B J - E American Samoa Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, LLC A and B MAC MAC A J - E Nevada Noridian Healthcare Solutions, LLC A and B MAC MAC B J - E Nevada Noridian Healthcare Solutions, LLC A and B MAC MAC A J - E American Samoa California - Entire State Guam Hawaii Nevada Northern Mariana Islands Back to Top LCD Information Document Information LCD ID L34215 Original ICD-9 LCD ID L33526 LCD Title Flow Cytometry AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT only copyright American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Printed on 10/4/2016. Page 1 of 29 Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 10/01/2016 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date N/A Notice Period End Date N/A

2 The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright American Dental Association. All rights reserved. CDT and CDT-2016 are trademarks of the American Dental Association. UB-04 Manual. OFFICIAL UB-04 DATA SPECIFICATIONS MANUAL, 2014, is copyrighted by American Hospital Association ( AHA ), Chicago, Illinois. No portion of OFFICIAL UB-04 MANUAL may be reproduced, sorted in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of AHA. Health Forum reserves the right to change the copyright notice from time to time upon written notice to Company. CMS National Coverage Policy Title XVIII of the Social Security Act (SSA), 1862(a)(1)(A), states that no Medicare payment shall be made for items or services that "are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of malformed body member." Title XVIII of the Social Security Act (SSA), 1862(a)(7) and 42 Code of Federal Regulations, , exclude routine physical examinations. Title XVIII of the Social Security Act (SSA), 1833(e), prohibits Medicare payment for any claim lacking the necessary documentation to process the claim. 42 CFR (d)(3) indicates diagnostic tests are payable only when the physician who is treating the beneficiary for a specific medical problem and who uses the results in such treatment. CMS Manual System, Publication , Medicare Program Integrity Manual, Chapter 3, , Diagnoses Code Requirement. CMS Manual System, Publication , Medicare Program Integrity Manual, Chapter 3, , Limitations of Liability Determinations CMS Manual System, Publication , Medicare National Coverage Determinations, Chapter 1, Section , Stem Cell Harvest and Transplantation Coverage Guidance Coverage Indications, Limitations, and/or Medical Necessity Flow cytometry (FCM) is a complex process to examine blood, body fluids, CSF, bone marrow, lymph node, tonsil, spleen and other solid tissues. The use of peripheral blood and fine needle aspirate material avoids more invasive procedures for diagnosis. A flow cytometer evaluates the physical and/or chemical characteristics of single cells as the cells pass individually in a fluid stream through a measuring device. Surface receptors, intracellular molecules, and DNA bind with fluorescent dyes that allow detection and evaluation. When light of one wave length excites electrons of certain chemicals to energy levels above their ground state and upon return to ground state emits light of a longer wavelength, fluorescence is produced. A flow cytometer detects cell characteristics by measuring the fluorescence produced by fluorochromes conjugated either directly with cell components or conjugated to antibodies directed against cell components. Indications Cytopenias and Hypercellular Hematolymphoid Disorders Hematolymphoid neoplasia can present with cytopenias (anemia, leucopenia and/or thrombocytopenia) or elevated leukocyte counts. If medical review and preliminary laboratory testing fails to reveal a cause, bone marrow aspiration and biopsy are indicated to rule out an infiltrative process or a stem cell disorder. FCM is essential to evaluate hematolymphoid lineages. Although anemia commonly occurs in nonneoplastic diseases, anemia alone should not automatically trigger FCM. Printed on 10/4/2016. Page 2 of 29

3 FCM may be useful in hypercellular hematolymphoid disorders to differentiate reactive conditions from neoplastic conditions. In the absence of blasts, neutrophilic leukocytosis is not generally an indication for FCM. Isolated polycythemia and basophilia are not sufficient to warrant FCM. Lymphomas In the current WHO classification, all non-hodgkin lymphomas (NHLs) are distinct clinicopathologic entities defined by their clinical features, morpholology, immunophenotype and, where appropriate, their genetic abnormalities. Immunophenotyping by FCM allows multiparameter evaluation of single cells and the ability to work on very small samples. Most new cases of suspected NHL undergo initial immunophenotypic analysis as part of the routine handling of a specimen. A standard lymphoma panel is designed to identify abnormal populations of B cells, T cells and/or NK cells. A standard lymphoma panel might include a combination of markers from the following categories: T cells (CD2, CD3, CD4, CD5, CD7, CD8); B cells (CD19, CD20, CD23); Kappa and lambda surface immunoglobulins light chains; plasma cells (CD38 and CD138); CALLA (CD10); CD45; CD56: FMC-7, CD103, CD11b, CD13, CD14, CD15, CD16 and CD34. The immunophenotypes of lymphomas are widely known and FCM allows appropriate classification of most cases. However, atypical patterns occur and pose significant diagnostic difficulties where aberrant antigen expression patterns must be reconciled with morphology. Additional markers may be required to characterize the abnormal population of cells including markers of immature cells (HLA-DR), B cells (CD22) and myeloid cells (CD14, CD15, CD33, CD64, CD117). Acute Leukemia The diagnosis and management of acute leukemia depend on the detection, identification and characterization of leukemic cells. The identification of leukemic cells is straightforward in most occasions. However, each acute leukemia subgroup has heterogeneous biologic characteristics, many of which are associated with a different response to therapy. As part of a routine diagnostic workup, most suspected acute leukemia cases undergo initial multiparameter immunophenotypic analysis, combined with morphology, cytochemistry, cytogenetics, and molecular biology. A standard acute leukemia FCM panel is designed to determine whether leukemic blasts are of myeloid or lymphoid origin, and then to further classify the neoplastic cells (myeloid blasts, B lymphoblasts, abnormal promyelocytes, monoblasts, etc). An acute leukemia panel might include a combination of cell markers from the following categories: stem cell lineage (CD34), immature cell lineage (HLA-DR, CD 10); T cell (CD2, CD3, CD4, CD5, CD7 and CD8); B cell (CD19, CD20); myeloid cell (CD13, CD14, CD15, CD 33, CD 64 and CD17); CD38, CD45, and CD56. When the routine panel is insufficient to characterize the leukemic cells, additional antibodies including erythroid markers (CD71 and glycophorin A), megakaryocytic markers (CD41, CD61) or cytoplasmic markers may be indicated. Chronic Lymphocytic Leukemia (CLL) & Other Chronic Lymphoproliferative Diseases (CLPD) The history, physical exam (lymphadenopathy, splenomegaly and/or hepatomegaly) laboratory findings (lymphocytosis, granulocytopenia, anemia, thrombocytopenia), and lymphocyte morphology are suggestive of CLL. The diagnosis is established by paradoxical co-expression of CD5 on peripheral lymphocytes that express B cell markers (CD19, CD20, CD21 and CD 23) with Kappa or lambda immunoglobulin light chain restriction. Additional markers such as CD38 and ZAP70 may provide important prognostic information. FCM can distinguish CLL, the peripheral counterpart of small lymphocytic lymphoma, often diagnosed in lymph node biopsies, from other indolent lymphocytic malignancies including prolymphocytic leukemia, Waldenstrom s macroglobulinemia, leukemic phase of lymphomas, hairy cell leukemia, T-cell CLL, adult T-cell leukemia, large granulocytic leukemia and cutaneous T-cell lymphoma and natural killer (NK) disorders including KIR expression. Plasma Cell Disorders Plasma cell disorders are often identified through a combination of clinical, laboratory studies (urine or serum gamma globulins), morphologic, and radiologic findings. FCM immunophenotyping is useful to identify abnormal plasma cells, and the distinction between lymphoid and plasma cell neoplasms, and between reactive plasma cells and neoplastic plasma cells. Printed on 10/4/2016. Page 3 of 29

4 The initial FCM workup for a plasma cell disorder may include the basic lymphoma panel markers with additional markers such as CD28 and CD117. Myelodysplastic Syndromes (MDS) The gold standard for an MDS diagnosis is assessment of bone marrow smears for dysplastic changes. FCM may assist in MDS determination through the identification of abnormal maturing myeloid cells. An abnormal phenotype by FCM is a minimal diagnostic MDS criteria to establish a definitive diagnosis. MDS has a definite risk and rate of progression to acute leukemia. Standard FCM leukemia panels are indicated to evaluate progression and onset of leukemia. Chronic Myeloproliferative Disorders (CMPD) Although genetic (Philadelphia chromosome and BCR/abl) and molecular studies (Jak 2) are the accepted cornerstone for the identification and classification of CMPDs, FCM may assist in the distinction from reactive hematopoietic proliferations and is important in the enumeration of blasts in the distinction from acute leukemia and an accelerated phase of CMPD. CMPD also has a definite risk and rate of progression to acute leukemia. Standard FCM leukemia panels are indicated to evaluate progression and onset of leukemia. Mast Cell Neoplasms Mast cell neoplasms are uncommon disorders. Mast cells coexpress multiple markers including CD9, CD33, CD45, CD68, CD117, but also lack several myelomonocytic antigens including CD14, CD15, CD16 and most T- and B- cells antigens. Neoplastic mast cells have a similar antigen profile, but also can coexpress CD2 and CD25, which helps in distinguishing malignant mast cells from mastocytosis. Paroxysmal hemoglobinuria (PNH) PNH is a rare clonal hematopoietic disorder of stem cells. This condition is caused by genetic mutation that results in the absence of over a dozen surface antigens on red and white blood cells. FCM can diagnose PNH by assessing both the red and white blood cells for the absence of these antigens. Minimal Residual Disease (MRD) FCM analysis for MRD must identify phenotypic features characteristic of the disease of interest. The MRD flow analysis should not rely on an exact match between the phenotype of the residual disease and the original diagnostic specimen because phenotypes can change over time and with treatment. The antibody combinations should be chosen to maximize detection of disease, limit the impact of phenotypic variation, and permit detection of disease following antibody directed therapy. HIV Infection HIV-1 infection causes significant changes in the number of CD4 and CD8 positive lymphocytes. CD4 count falls roughly 30% while CD8 count increases within 6 months after seroconversion, causing a decrease in the CD4/CD8 ratio Following HIV-1 diagnosis, FCM should include enumeration of mature T cells (CD3), helper T cells (CD4) and suppressor T cells (CD8) to ensure all major T cell subsets are accounted for (the sum of helper CD4 and suppressor CD8 T cells is roughly close to the total number of CD3 positive T cells). This ensures that the absolute CD4 is not artificially decreased due to sample degradation or other artifact. A WBC count with differential also needs to be performed to calculate the absolute CD4 count (absolute lymphocyte count times CD4%). Organ Transplants In order to differentiate early rejection, immunosuppressive therapy toxicity or infection, FCM may be indicated to monitor postoperative organ transplants. CD3 is useful to monitor the effectiveness of certain immunosuppressive therapies. When the transplant patient demonstrates symptoms for the above conditions, repeated analysis may be required. DNA Analysis Printed on 10/4/2016. Page 4 of 29

5 Carcinoma, Non-hematolymphoid Tumors DNA analysis of tumor for ploidy and percent S-phase cells may be necessary for a few selective patients with carcinomas. When the obtained prognostic information will affect treatment decisions in patients with low stage (localized) disease, FCM results are useful. Molar Pregnancy FCM is useful to evaluate molar and partial molar pregnancies. Using a method to quantify DNA, similar to that used for evaluation of carcinomas, partial moles (triploid), can be distinguished from normal placenta and complete molar (diploid) pregnancies. Primary Immunodeficiencies(PIDS) PIDs are rare disorders that reflect inherited abnormalities in the development and maturation of cells responsible for immune function. More than 120 inherited immunodeficiency disorders are currently recognized. Affected individuals are prone to repeated infections, allergies, autoimmune disorders, and malignancies. Diagnosis typically occurs at an early age. FCM may be indicated for diagnostic purposes and is usually limited to T (CD3, CD4, CD8), B (CD20) and NK cell (CD56) markers. Additional disease specific markers may be indicated. Primary Platelet Disorders, Non-neoplastic FCM is used for platelet analysis in quantitative and qualitative disorders such as Glanzmann Thrombasthenia (GT) and Bernard-Soulier Disease (B-S). GT is a rare inherited or acquired platelet disorder. Hereditary GT is defined by platelets with decreased expression or absence of the GPIIa/GPIIIb receptor. This receptor is responsible for the initial platelet plug at the site of endothelial injury. Absence if the receptor may result in increased bleeding. Acquired GT is likely an autoimmune phenomenon with the presence of GPIIb/GPIIIa blocking antibodies. FCM may be used to determine the functional effect and identity the molecular targets of these antibodies. B-S is another rare inherited disorder that prevents the initial binding of platelets at the site of endothelial injury by absence of or presence of abnormal surface GPIa/V/IX receptor. Abnormalities of this receptor prevent attachment of platelets to subendothelial or free von Willebrand s factor with subsequent tendency to bleed. FCM may be used to measure antibodies directed at specific loci of the GPIa/V/IX receptor, which include GPIb (CD42b), GPIX (CD42a), and GPV (CD42d). FCM is also used to assess the size of platelets in the initial evaluation of B-S disease. In B-S disease, platelets are generally larger than normal. FCM can distinguish B-S platelets from fragmented RBCs and debris by antibodies directed to the GPIb/IX/V receptor. Red Cell and White Cell Disorders, Non-neoplastic FCM is a valuable tool to establish abnormal or defective red blood cell, leukocyte and lymphocyte surface receptors, transmembrane molecules, and intracellular DNA. It may be used in acquired and congenital red cell conditions such as in quantifying fetomaternal hemorrhage and hereditary spherocytosis, hereditary elliptocytosis, and hereditary persistence of fetal hemoglobin in the context of compound hemoglobinopathy syndromes. FCM is a sensitive and specific method to identify leukocyte receptor abnormalities for the diagnosis of chronic granulomatous disease and CD11b deficiency. It is an efficient method to identify lymphocytes HLA B27 associated with uveitis, ankylosing spondylitis, Reiter s syndrome and sacroiliitis. Limitations: Since FCM immunophenotypes for most common lymphomas and leukemias are well characterized, Noridian does NOT consider it reasonable and necessary to perform more than 24 markers in a panel. When atypical or unusual FCM results are obtained, the selective addition of more markers may be indicated. The flow report must document the specific indication for each marker over the 24 marker limit. The FCM report must document the specific indication for each marker over the 24-marker limit. FCM reports without clear justification for each marker over 24 will be denied. Back to Top Printed on 10/4/2016. Page 5 of 29

6 Coding Information Bill Type : Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims. 012x Hospital Inpatient (Medicare Part B only) 013x Hospital Outpatient 014x Hospital - Laboratory Services Provided to Non-patients 018x Hospital - Swing Beds 021x Skilled Nursing - Inpatient (Including Medicare Part A) 022x Skilled Nursing - Inpatient (Medicare Part B only) 023x Skilled Nursing - Outpatient 071x Clinic - Rural Health 077x Clinic - Federally Qualified Health Center (FQHC) 085x Critical Access Hospital Revenue : Contractors may specify Revenue to help providers identify those Revenue typically used to report this service. In most instances Revenue are purely advisory. Unless specified in the policy, services reported under other Revenue are equally subject to this coverage determination. Complete absence of all Revenue indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Laboratory - General Classification 0302 Laboratory - Immunology 0309 Laboratory - Other Laboratory CPT/HCPCS Group 1 Paragraph: Note: The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web. For CPT code long descriptors, refer to the current version of CPT. Group 1 : Cell marker study Flowcytometry/ tc 1 marker Flowcytometry/tc add-on Flowcytometry/read Flowcytometry/read Flowcytometry/read 16 & > Group 2 Paragraph: Quantitative in immunology section: Group 2 : B cells total count Mononuclear cell antigen Nk cells total count T cells total count T cell absolute count/ratio T cell absolute count Stem cells total count Printed on 10/4/2016. Page 6 of 29

7 that Support Medical Necessity Group 1 Paragraph: Providers should continue to submit ICD-10-CM diagnosis codes without decimals on their claim forms and electronic claims. The CPT/HCPCS codes included in this LCD will be subjected to procedure to diagnosis editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary. Medicare is establishing the following limited coverage for CPT/HCPCS codes 88182, 88184, 88185, 88187, 88188, 88189, 86355, 86356, 86357, 86359, 86360, and 86367: Group 1 : ICD-10 A18.01 Tuberculosis of spine B20 Human immunodeficiency virus [HIV] disease B97.33 Human T-cell lymphotrophic virus, type I [HTLV-I] as the cause of diseases classified elsewhere B97.34 Human T-cell lymphotrophic virus, type II [HTLV-II] as the cause of diseases classified elsewhere B97.35 Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere C15.3 Malignant neoplasm of upper third of esophagus C15.4 Malignant neoplasm of middle third of esophagus C15.5 Malignant neoplasm of lower third of esophagus C15.8 Malignant neoplasm of overlapping sites of esophagus C16.0 Malignant neoplasm of cardia C16.1 Malignant neoplasm of fundus of stomach C16.2 Malignant neoplasm of body of stomach C16.3 Malignant neoplasm of pyloric antrum C16.4 Malignant neoplasm of pylorus C16.8 Malignant neoplasm of overlapping sites of stomach C17.0 Malignant neoplasm of duodenum C17.1 Malignant neoplasm of jejunum C17.2 Malignant neoplasm of ileum C17.8 Malignant neoplasm of overlapping sites of small intestine C18.0 Malignant neoplasm of cecum C18.1 Malignant neoplasm of appendix C18.2 Malignant neoplasm of ascending colon C18.3 Malignant neoplasm of hepatic flexure C18.4 Malignant neoplasm of transverse colon C18.5 Malignant neoplasm of splenic flexure C18.6 Malignant neoplasm of descending colon C18.7 Malignant neoplasm of sigmoid colon C18.8 Malignant neoplasm of overlapping sites of colon C19 Malignant neoplasm of rectosigmoid junction C20 Malignant neoplasm of rectum C21.1 Malignant neoplasm of anal canal C21.2 Malignant neoplasm of cloacogenic zone C21.8 Malignant neoplasm of overlapping sites of rectum, anus and anal canal C22.0 Liver cell carcinoma C22.2 Hepatoblastoma C22.3 Angiosarcoma of liver C22.4 Other sarcomas of liver C22.7 Other specified carcinomas of liver C22.9 Malignant neoplasm of liver, not specified as primary or secondary C23 Malignant neoplasm of gallbladder C24.0 Malignant neoplasm of extrahepatic bile duct C24.1 Malignant neoplasm of ampulla of Vater C25.0 Malignant neoplasm of head of pancreas C25.1 Malignant neoplasm of body of pancreas C25.2 Malignant neoplasm of tail of pancreas Printed on 10/4/2016. Page 7 of 29

8 C25.7 Malignant neoplasm of other parts of pancreas C25.8 Malignant neoplasm of overlapping sites of pancreas C26.1 Malignant neoplasm of spleen C26.9 Malignant neoplasm of ill-defined sites within the digestive system C30.0 Malignant neoplasm of nasal cavity C30.1 Malignant neoplasm of middle ear C31.0 Malignant neoplasm of maxillary sinus C31.1 Malignant neoplasm of ethmoidal sinus C31.2 Malignant neoplasm of frontal sinus C31.3 Malignant neoplasm of sphenoid sinus C31.8 Malignant neoplasm of overlapping sites of accessory sinuses C32.0 Malignant neoplasm of glottis C32.1 Malignant neoplasm of supraglottis C32.2 Malignant neoplasm of subglottis C32.3 Malignant neoplasm of laryngeal cartilage C32.8 Malignant neoplasm of overlapping sites of larynx C33 Malignant neoplasm of trachea C34.01 Malignant neoplasm of right main bronchus C34.02 Malignant neoplasm of left main bronchus C34.11 Malignant neoplasm of upper lobe, right bronchus or lung C34.12 Malignant neoplasm of upper lobe, left bronchus or lung C34.2 Malignant neoplasm of middle lobe, bronchus or lung C34.31 Malignant neoplasm of lower lobe, right bronchus or lung C34.32 Malignant neoplasm of lower lobe, left bronchus or lung C34.81 Malignant neoplasm of overlapping sites of right bronchus and lung C34.82 Malignant neoplasm of overlapping sites of left bronchus and lung C37 Malignant neoplasm of thymus C38.1 Malignant neoplasm of anterior mediastinum C38.2 Malignant neoplasm of posterior mediastinum C38.4 Malignant neoplasm of pleura C38.8 Malignant neoplasm of overlapping sites of heart, mediastinum and pleura C40.01 Malignant neoplasm of scapula and long bones of right upper limb C40.02 Malignant neoplasm of scapula and long bones of left upper limb C40.11 Malignant neoplasm of short bones of right upper limb C40.12 Malignant neoplasm of short bones of left upper limb C40.21 Malignant neoplasm of long bones of right lower limb C40.22 Malignant neoplasm of long bones of left lower limb C40.31 Malignant neoplasm of short bones of right lower limb C40.32 Malignant neoplasm of short bones of left lower limb C40.81 Malignant neoplasm of overlapping sites of bone and articular cartilage of right limb C40.82 Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb C41.0 Malignant neoplasm of bones of skull and face C41.2 Malignant neoplasm of vertebral column C41.3 Malignant neoplasm of ribs, sternum and clavicle C41.4 Malignant neoplasm of pelvic bones, sacrum and coccyx C44.01 Basal cell carcinoma of skin of lip C44.02 Squamous cell carcinoma of skin of lip C44.09 Other specified malignant neoplasm of skin of lip C Basal cell carcinoma of skin of right eyelid, including canthus C Basal cell carcinoma of skin of left eyelid, including canthus C Squamous cell carcinoma of skin of right eyelid, including canthus C Squamous cell carcinoma of skin of left eyelid, including canthus C Other specified malignant neoplasm of skin of right eyelid, including canthus C Other specified malignant neoplasm of skin of left eyelid, including canthus C Basal cell carcinoma of skin of right ear and external auricular canal C Basal cell carcinoma of skin of left ear and external auricular canal C Squamous cell carcinoma of skin of right ear and external auricular canal C Squamous cell carcinoma of skin of left ear and external auricular canal Printed on 10/4/2016. Page 8 of 29

9 C Other specified malignant neoplasm of skin of right ear and external auricular canal C Other specified malignant neoplasm of skin of left ear and external auricular canal C Basal cell carcinoma of skin of nose C Basal cell carcinoma of skin of other parts of face C Squamous cell carcinoma of skin of nose C Squamous cell carcinoma of skin of other parts of face C Other specified malignant neoplasm of skin of nose C Other specified malignant neoplasm of skin of other parts of face C44.41 Basal cell carcinoma of skin of scalp and neck C44.42 Squamous cell carcinoma of skin of scalp and neck C44.49 Other specified malignant neoplasm of skin of scalp and neck C Basal cell carcinoma of anal skin C Basal cell carcinoma of skin of breast C Basal cell carcinoma of skin of other part of trunk C Squamous cell carcinoma of anal skin C Squamous cell carcinoma of skin of breast C Squamous cell carcinoma of skin of other part of trunk C Other specified malignant neoplasm of anal skin C Other specified malignant neoplasm of skin of breast C Other specified malignant neoplasm of skin of other part of trunk C Basal cell carcinoma of skin of right upper limb, including shoulder C Basal cell carcinoma of skin of left upper limb, including shoulder C Squamous cell carcinoma of skin of right upper limb, including shoulder C Squamous cell carcinoma of skin of left upper limb, including shoulder C Other specified malignant neoplasm of skin of right upper limb, including shoulder C Other specified malignant neoplasm of skin of left upper limb, including shoulder C Basal cell carcinoma of skin of right lower limb, including hip C Basal cell carcinoma of skin of left lower limb, including hip C Squamous cell carcinoma of skin of right lower limb, including hip C Squamous cell carcinoma of skin of left lower limb, including hip C Other specified malignant neoplasm of skin of right lower limb, including hip C Other specified malignant neoplasm of skin of left lower limb, including hip C44.81 Basal cell carcinoma of overlapping sites of skin C44.82 Squamous cell carcinoma of overlapping sites of skin C44.89 Other specified malignant neoplasm of overlapping sites of skin C45.0 Mesothelioma of pleura C45.1 Mesothelioma of peritoneum C45.7 Mesothelioma of other sites C46.0 Kaposi's sarcoma of skin C46.1 Kaposi's sarcoma of soft tissue C46.2 Kaposi's sarcoma of palate C46.3 Kaposi's sarcoma of lymph nodes C46.4 Kaposi's sarcoma of gastrointestinal sites C46.51 Kaposi's sarcoma of right lung C46.52 Kaposi's sarcoma of left lung C46.7 Kaposi's sarcoma of other sites C47.0 Malignant neoplasm of peripheral nerves of head, face and neck C47.11 Malignant neoplasm of peripheral nerves of right upper limb, including shoulder C47.12 Malignant neoplasm of peripheral nerves of left upper limb, including shoulder C47.21 Malignant neoplasm of peripheral nerves of right lower limb, including hip C47.22 Malignant neoplasm of peripheral nerves of left lower limb, including hip C47.3 Malignant neoplasm of peripheral nerves of thorax C47.4 Malignant neoplasm of peripheral nerves of abdomen C47.5 Malignant neoplasm of peripheral nerves of pelvis C47.8 Malignant neoplasm of overlapping sites of peripheral nerves and autonomic nervous system C48.0 Malignant neoplasm of retroperitoneum C48.1 Malignant neoplasm of specified parts of peritoneum Printed on 10/4/2016. Page 9 of 29

10 C48.8 Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum C49.0 Malignant neoplasm of connective and soft tissue of head, face and neck C49.11 Malignant neoplasm of connective and soft tissue of right upper limb, including shoulder C49.12 Malignant neoplasm of connective and soft tissue of left upper limb, including shoulder C49.21 Malignant neoplasm of connective and soft tissue of right lower limb, including hip C49.22 Malignant neoplasm of connective and soft tissue of left lower limb, including hip C49.3 Malignant neoplasm of connective and soft tissue of thorax C49.4 Malignant neoplasm of connective and soft tissue of abdomen C49.5 Malignant neoplasm of connective and soft tissue of pelvis C49.8 Malignant neoplasm of overlapping sites of connective and soft tissue C49.A0 Gastrointestinal stromal tumor, unspecified site C49.A1 Gastrointestinal stromal tumor of esophagus C49.A2 Gastrointestinal stromal tumor of stomach C49.A3 Gastrointestinal stromal tumor of small intestine C49.A4 Gastrointestinal stromal tumor of large intestine C49.A5 Gastrointestinal stromal tumor of rectum C49.A9 Gastrointestinal stromal tumor of other sites C Malignant neoplasm of nipple and areola, right female breast C Malignant neoplasm of nipple and areola, left female breast C Malignant neoplasm of nipple and areola, right male breast C Malignant neoplasm of nipple and areola, left male breast C Malignant neoplasm of central portion of right female breast C Malignant neoplasm of central portion of left female breast C Malignant neoplasm of central portion of right male breast C Malignant neoplasm of central portion of left male breast C Malignant neoplasm of upper-inner quadrant of right female breast C Malignant neoplasm of upper-inner quadrant of left female breast C Malignant neoplasm of upper-inner quadrant of right male breast C Malignant neoplasm of upper-inner quadrant of left male breast C Malignant neoplasm of lower-inner quadrant of right female breast C Malignant neoplasm of lower-inner quadrant of left female breast C Malignant neoplasm of lower-inner quadrant of right male breast C Malignant neoplasm of lower-inner quadrant of left male breast C Malignant neoplasm of upper-outer quadrant of right female breast C Malignant neoplasm of upper-outer quadrant of left female breast C Malignant neoplasm of upper-outer quadrant of right male breast C Malignant neoplasm of upper-outer quadrant of left male breast C Malignant neoplasm of lower-outer quadrant of right female breast C Malignant neoplasm of lower-outer quadrant of left female breast C Malignant neoplasm of lower-outer quadrant of right male breast C Malignant neoplasm of lower-outer quadrant of left male breast C Malignant neoplasm of axillary tail of right female breast C Malignant neoplasm of axillary tail of left female breast C Malignant neoplasm of axillary tail of right male breast C Malignant neoplasm of axillary tail of left male breast C Malignant neoplasm of overlapping sites of right female breast C Malignant neoplasm of overlapping sites of left female breast C Malignant neoplasm of overlapping sites of right male breast C Malignant neoplasm of overlapping sites of left male breast C51.0 Malignant neoplasm of labium majus C51.1 Malignant neoplasm of labium minus C51.2 Malignant neoplasm of clitoris C51.8 Malignant neoplasm of overlapping sites of vulva C52 Malignant neoplasm of vagina C53.0 Malignant neoplasm of endocervix C53.1 Malignant neoplasm of exocervix C53.8 Malignant neoplasm of overlapping sites of cervix uteri C54.0 Malignant neoplasm of isthmus uteri Printed on 10/4/2016. Page 10 of 29

11 C54.1 Malignant neoplasm of endometrium C54.2 Malignant neoplasm of myometrium C54.3 Malignant neoplasm of fundus uteri C54.8 Malignant neoplasm of overlapping sites of corpus uteri C56.1 Malignant neoplasm of right ovary C56.2 Malignant neoplasm of left ovary C57.7 Malignant neoplasm of other specified female genital organs C57.8 Malignant neoplasm of overlapping sites of female genital organs C58 Malignant neoplasm of placenta C60.0 Malignant neoplasm of prepuce C60.1 Malignant neoplasm of glans penis C60.2 Malignant neoplasm of body of penis C60.8 Malignant neoplasm of overlapping sites of penis C61 Malignant neoplasm of prostate C62.01 Malignant neoplasm of undescended right testis C62.02 Malignant neoplasm of undescended left testis C62.11 Malignant neoplasm of descended right testis C62.12 Malignant neoplasm of descended left testis C63.01 Malignant neoplasm of right epididymis C63.02 Malignant neoplasm of left epididymis C63.11 Malignant neoplasm of right spermatic cord C63.12 Malignant neoplasm of left spermatic cord C63.2 Malignant neoplasm of scrotum C63.7 Malignant neoplasm of other specified male genital organs C63.8 Malignant neoplasm of overlapping sites of male genital organs C64.1 Malignant neoplasm of right kidney, except renal pelvis C64.2 Malignant neoplasm of left kidney, except renal pelvis C65.1 Malignant neoplasm of right renal pelvis C65.2 Malignant neoplasm of left renal pelvis C66.1 Malignant neoplasm of right ureter C66.2 Malignant neoplasm of left ureter C67.0 Malignant neoplasm of trigone of bladder C67.1 Malignant neoplasm of dome of bladder C67.2 Malignant neoplasm of lateral wall of bladder C67.3 Malignant neoplasm of anterior wall of bladder C67.4 Malignant neoplasm of posterior wall of bladder C67.5 Malignant neoplasm of bladder neck C67.6 Malignant neoplasm of ureteric orifice C67.7 Malignant neoplasm of urachus C67.8 Malignant neoplasm of overlapping sites of bladder C68.0 Malignant neoplasm of urethra C68.1 Malignant neoplasm of paraurethral glands C68.8 Malignant neoplasm of overlapping sites of urinary organs C69.01 Malignant neoplasm of right conjunctiva C69.02 Malignant neoplasm of left conjunctiva C69.11 Malignant neoplasm of right cornea C69.12 Malignant neoplasm of left cornea C69.21 Malignant neoplasm of right retina C69.22 Malignant neoplasm of left retina C69.31 Malignant neoplasm of right choroid C69.32 Malignant neoplasm of left choroid C69.41 Malignant neoplasm of right ciliary body C69.42 Malignant neoplasm of left ciliary body C69.51 Malignant neoplasm of right lacrimal gland and duct C69.52 Malignant neoplasm of left lacrimal gland and duct C69.61 Malignant neoplasm of right orbit C69.62 Malignant neoplasm of left orbit Printed on 10/4/2016. Page 11 of 29

12 C69.81 Malignant neoplasm of overlapping sites of right eye and adnexa C69.82 Malignant neoplasm of overlapping sites of left eye and adnexa C70.0 Malignant neoplasm of cerebral meninges C70.1 Malignant neoplasm of spinal meninges C71.0 Malignant neoplasm of cerebrum, except lobes and ventricles C71.1 Malignant neoplasm of frontal lobe C71.2 Malignant neoplasm of temporal lobe C71.3 Malignant neoplasm of parietal lobe C71.4 Malignant neoplasm of occipital lobe C71.5 Malignant neoplasm of cerebral ventricle C71.6 Malignant neoplasm of cerebellum C71.7 Malignant neoplasm of brain stem C71.8 Malignant neoplasm of overlapping sites of brain C72.0 Malignant neoplasm of spinal cord C72.1 Malignant neoplasm of cauda equina C72.21 Malignant neoplasm of right olfactory nerve C72.22 Malignant neoplasm of left olfactory nerve C72.31 Malignant neoplasm of right optic nerve C72.32 Malignant neoplasm of left optic nerve C72.41 Malignant neoplasm of right acoustic nerve C72.42 Malignant neoplasm of left acoustic nerve C72.59 Malignant neoplasm of other cranial nerves C73 Malignant neoplasm of thyroid gland C74.01 Malignant neoplasm of cortex of right adrenal gland C74.02 Malignant neoplasm of cortex of left adrenal gland C74.11 Malignant neoplasm of medulla of right adrenal gland C74.12 Malignant neoplasm of medulla of left adrenal gland C75.0 Malignant neoplasm of parathyroid gland C75.1 Malignant neoplasm of pituitary gland C75.2 Malignant neoplasm of craniopharyngeal duct C75.3 Malignant neoplasm of pineal gland C75.4 Malignant neoplasm of carotid body C75.5 Malignant neoplasm of aortic body and other paraganglia C76.0 Malignant neoplasm of head, face and neck C76.1 Malignant neoplasm of thorax C76.2 Malignant neoplasm of abdomen C76.3 Malignant neoplasm of pelvis C76.41 Malignant neoplasm of right upper limb C76.42 Malignant neoplasm of left upper limb C76.51 Malignant neoplasm of right lower limb C76.52 Malignant neoplasm of left lower limb C76.8 Malignant neoplasm of other specified ill-defined sites C78.01 Secondary malignant neoplasm of right lung C78.02 Secondary malignant neoplasm of left lung C78.1 Secondary malignant neoplasm of mediastinum C78.2 Secondary malignant neoplasm of pleura C78.39 Secondary malignant neoplasm of other respiratory organs C78.4 Secondary malignant neoplasm of small intestine C78.5 Secondary malignant neoplasm of large intestine and rectum C78.6 Secondary malignant neoplasm of retroperitoneum and peritoneum C79.01 Secondary malignant neoplasm of right kidney and renal pelvis C79.02 Secondary malignant neoplasm of left kidney and renal pelvis C79.11 Secondary malignant neoplasm of bladder C79.19 Secondary malignant neoplasm of other urinary organs C79.2 Secondary malignant neoplasm of skin C79.31 Secondary malignant neoplasm of brain C79.32 Secondary malignant neoplasm of cerebral meninges C79.49 Secondary malignant neoplasm of other parts of nervous system Printed on 10/4/2016. Page 12 of 29

13 C79.51 Secondary malignant neoplasm of bone C79.52 Secondary malignant neoplasm of bone marrow C79.61 Secondary malignant neoplasm of right ovary C79.62 Secondary malignant neoplasm of left ovary C79.71 Secondary malignant neoplasm of right adrenal gland C79.72 Secondary malignant neoplasm of left adrenal gland C79.81 Secondary malignant neoplasm of breast C79.82 Secondary malignant neoplasm of genital organs C81.01 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of head, face, and neck C81.02 Nodular lymphocyte predominant Hodgkin lymphoma, intrathoracic lymph nodes C81.03 Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes C81.04 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of axilla and upper limb C81.05 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of inguinal region and lower limb C81.06 Nodular lymphocyte predominant Hodgkin lymphoma, intrapelvic lymph nodes C81.07 Nodular lymphocyte predominant Hodgkin lymphoma, spleen C81.08 Nodular lymphocyte predominant Hodgkin lymphoma, lymph nodes of multiple sites C81.09 Nodular lymphocyte predominant Hodgkin lymphoma, extranodal and solid organ sites C81.11 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck C81.12 Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes C81.13 Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes C81.14 Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb C81.15 Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb C81.16 Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes C81.17 Nodular sclerosis Hodgkin lymphoma, spleen C81.18 Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites C81.19 Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites C81.21 Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck C81.22 Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes C81.23 Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes C81.24 Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb C81.25 Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb C81.26 Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes C81.27 Mixed cellularity Hodgkin lymphoma, spleen C81.28 Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites C81.29 Mixed cellularity Hodgkin lymphoma, extranodal and solid organ sites C81.31 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck C81.32 Lymphocyte depleted Hodgkin lymphoma, intrathoracic lymph nodes C81.33 Lymphocyte depleted Hodgkin lymphoma, intra-abdominal lymph nodes C81.34 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of axilla and upper limb C81.35 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of inguinal region and lower limb C81.36 Lymphocyte depleted Hodgkin lymphoma, intrapelvic lymph nodes C81.37 Lymphocyte depleted Hodgkin lymphoma, spleen C81.38 Lymphocyte depleted Hodgkin lymphoma, lymph nodes of multiple sites C81.39 Lymphocyte depleted Hodgkin lymphoma, extranodal and solid organ sites C81.41 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of head, face, and neck C81.42 Lymphocyte-rich Hodgkin lymphoma, intrathoracic lymph nodes C81.43 Lymphocyte-rich Hodgkin lymphoma, intra-abdominal lymph nodes C81.44 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of axilla and upper limb C81.45 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of inguinal region and lower limb C81.46 Lymphocyte-rich Hodgkin lymphoma, intrapelvic lymph nodes C81.47 Lymphocyte-rich Hodgkin lymphoma, spleen C81.48 Lymphocyte-rich Hodgkin lymphoma, lymph nodes of multiple sites C81.49 Lymphocyte-rich Hodgkin lymphoma, extranodal and solid organ sites C81.71 Other Hodgkin lymphoma, lymph nodes of head, face, and neck C81.72 Other Hodgkin lymphoma, intrathoracic lymph nodes C81.73 Other Hodgkin lymphoma, intra-abdominal lymph nodes C81.74 Other Hodgkin lymphoma, lymph nodes of axilla and upper limb Printed on 10/4/2016. Page 13 of 29

14 C81.75 Other Hodgkin lymphoma, lymph nodes of inguinal region and lower limb C81.76 Other Hodgkin lymphoma, intrapelvic lymph nodes C81.77 Other Hodgkin lymphoma, spleen C81.78 Other Hodgkin lymphoma, lymph nodes of multiple sites C81.79 Other Hodgkin lymphoma, extranodal and solid organ sites C82.01 Follicular lymphoma grade I, lymph nodes of head, face, and neck C82.02 Follicular lymphoma grade I, intrathoracic lymph nodes C82.03 Follicular lymphoma grade I, intra-abdominal lymph nodes C82.04 Follicular lymphoma grade I, lymph nodes of axilla and upper limb C82.05 Follicular lymphoma grade I, lymph nodes of inguinal region and lower limb C82.06 Follicular lymphoma grade I, intrapelvic lymph nodes C82.07 Follicular lymphoma grade I, spleen C82.08 Follicular lymphoma grade I, lymph nodes of multiple sites C82.09 Follicular lymphoma grade I, extranodal and solid organ sites C82.11 Follicular lymphoma grade II, lymph nodes of head, face, and neck C82.12 Follicular lymphoma grade II, intrathoracic lymph nodes C82.13 Follicular lymphoma grade II, intra-abdominal lymph nodes C82.14 Follicular lymphoma grade II, lymph nodes of axilla and upper limb C82.15 Follicular lymphoma grade II, lymph nodes of inguinal region and lower limb C82.16 Follicular lymphoma grade II, intrapelvic lymph nodes C82.17 Follicular lymphoma grade II, spleen C82.18 Follicular lymphoma grade II, lymph nodes of multiple sites C82.19 Follicular lymphoma grade II, extranodal and solid organ sites C82.31 Follicular lymphoma grade IIIa, lymph nodes of head, face, and neck C82.32 Follicular lymphoma grade IIIa, intrathoracic lymph nodes C82.33 Follicular lymphoma grade IIIa, intra-abdominal lymph nodes C82.34 Follicular lymphoma grade IIIa, lymph nodes of axilla and upper limb C82.35 Follicular lymphoma grade IIIa, lymph nodes of inguinal region and lower limb C82.36 Follicular lymphoma grade IIIa, intrapelvic lymph nodes C82.37 Follicular lymphoma grade IIIa, spleen C82.38 Follicular lymphoma grade IIIa, lymph nodes of multiple sites C82.39 Follicular lymphoma grade IIIa, extranodal and solid organ sites C82.41 Follicular lymphoma grade IIIb, lymph nodes of head, face, and neck C82.42 Follicular lymphoma grade IIIb, intrathoracic lymph nodes C82.43 Follicular lymphoma grade IIIb, intra-abdominal lymph nodes C82.44 Follicular lymphoma grade IIIb, lymph nodes of axilla and upper limb C82.45 Follicular lymphoma grade IIIb, lymph nodes of inguinal region and lower limb C82.46 Follicular lymphoma grade IIIb, intrapelvic lymph nodes C82.47 Follicular lymphoma grade IIIb, spleen C82.48 Follicular lymphoma grade IIIb, lymph nodes of multiple sites C82.49 Follicular lymphoma grade IIIb, extranodal and solid organ sites C82.51 Diffuse follicle center lymphoma, lymph nodes of head, face, and neck C82.52 Diffuse follicle center lymphoma, intrathoracic lymph nodes C82.53 Diffuse follicle center lymphoma, intra-abdominal lymph nodes C82.54 Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb C82.55 Diffuse follicle center lymphoma, lymph nodes of inguinal region and lower limb C82.56 Diffuse follicle center lymphoma, intrapelvic lymph nodes C82.57 Diffuse follicle center lymphoma, spleen C82.58 Diffuse follicle center lymphoma, lymph nodes of multiple sites C82.59 Diffuse follicle center lymphoma, extranodal and solid organ sites C82.61 Cutaneous follicle center lymphoma, lymph nodes of head, face, and neck C82.62 Cutaneous follicle center lymphoma, intrathoracic lymph nodes C82.63 Cutaneous follicle center lymphoma, intra-abdominal lymph nodes C82.64 Cutaneous follicle center lymphoma, lymph nodes of axilla and upper limb C82.65 Cutaneous follicle center lymphoma, lymph nodes of inguinal region and lower limb C82.66 Cutaneous follicle center lymphoma, intrapelvic lymph nodes C82.67 Cutaneous follicle center lymphoma, spleen Printed on 10/4/2016. Page 14 of 29

15 C82.68 Cutaneous follicle center lymphoma, lymph nodes of multiple sites C82.69 Cutaneous follicle center lymphoma, extranodal and solid organ sites C82.81 Other types of follicular lymphoma, lymph nodes of head, face, and neck C82.82 Other types of follicular lymphoma, intrathoracic lymph nodes C82.83 Other types of follicular lymphoma, intra-abdominal lymph nodes C82.84 Other types of follicular lymphoma, lymph nodes of axilla and upper limb C82.85 Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb C82.86 Other types of follicular lymphoma, intrapelvic lymph nodes C82.87 Other types of follicular lymphoma, spleen C82.88 Other types of follicular lymphoma, lymph nodes of multiple sites C82.89 Other types of follicular lymphoma, extranodal and solid organ sites C83.01 Small cell B-cell lymphoma, lymph nodes of head, face, and neck C83.02 Small cell B-cell lymphoma, intrathoracic lymph nodes C83.03 Small cell B-cell lymphoma, intra-abdominal lymph nodes C83.04 Small cell B-cell lymphoma, lymph nodes of axilla and upper limb C83.05 Small cell B-cell lymphoma, lymph nodes of inguinal region and lower limb C83.06 Small cell B-cell lymphoma, intrapelvic lymph nodes C83.07 Small cell B-cell lymphoma, spleen C83.08 Small cell B-cell lymphoma, lymph nodes of multiple sites C83.09 Small cell B-cell lymphoma, extranodal and solid organ sites C83.11 Mantle cell lymphoma, lymph nodes of head, face, and neck C83.12 Mantle cell lymphoma, intrathoracic lymph nodes C83.13 Mantle cell lymphoma, intra-abdominal lymph nodes C83.14 Mantle cell lymphoma, lymph nodes of axilla and upper limb C83.15 Mantle cell lymphoma, lymph nodes of inguinal region and lower limb C83.16 Mantle cell lymphoma, intrapelvic lymph nodes C83.17 Mantle cell lymphoma, spleen C83.18 Mantle cell lymphoma, lymph nodes of multiple sites C83.19 Mantle cell lymphoma, extranodal and solid organ sites C83.31 Diffuse large B-cell lymphoma, lymph nodes of head, face, and neck C83.32 Diffuse large B-cell lymphoma, intrathoracic lymph nodes C83.33 Diffuse large B-cell lymphoma, intra-abdominal lymph nodes C83.34 Diffuse large B-cell lymphoma, lymph nodes of axilla and upper limb C83.35 Diffuse large B-cell lymphoma, lymph nodes of inguinal region and lower limb C83.36 Diffuse large B-cell lymphoma, intrapelvic lymph nodes C83.37 Diffuse large B-cell lymphoma, spleen C83.38 Diffuse large B-cell lymphoma, lymph nodes of multiple sites C83.39 Diffuse large B-cell lymphoma, extranodal and solid organ sites C83.51 Lymphoblastic (diffuse) lymphoma, lymph nodes of head, face, and neck C83.52 Lymphoblastic (diffuse) lymphoma, intrathoracic lymph nodes C83.53 Lymphoblastic (diffuse) lymphoma, intra-abdominal lymph nodes C83.54 Lymphoblastic (diffuse) lymphoma, lymph nodes of axilla and upper limb C83.55 Lymphoblastic (diffuse) lymphoma, lymph nodes of inguinal region and lower limb C83.56 Lymphoblastic (diffuse) lymphoma, intrapelvic lymph nodes C83.57 Lymphoblastic (diffuse) lymphoma, spleen C83.58 Lymphoblastic (diffuse) lymphoma, lymph nodes of multiple sites C83.59 Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites C83.71 Burkitt lymphoma, lymph nodes of head, face, and neck C83.72 Burkitt lymphoma, intrathoracic lymph nodes C83.73 Burkitt lymphoma, intra-abdominal lymph nodes C83.74 Burkitt lymphoma, lymph nodes of axilla and upper limb C83.75 Burkitt lymphoma, lymph nodes of inguinal region and lower limb C83.76 Burkitt lymphoma, intrapelvic lymph nodes C83.77 Burkitt lymphoma, spleen C83.78 Burkitt lymphoma, lymph nodes of multiple sites C83.79 Burkitt lymphoma, extranodal and solid organ sites C83.81 Other non-follicular lymphoma, lymph nodes of head, face, and neck C83.82 Other non-follicular lymphoma, intrathoracic lymph nodes Printed on 10/4/2016. Page 15 of 29