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C25 ICD-10-CM Code: Malignant neoplasm of pancreas

C25 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC Buddy coding tools

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FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of digestive organs (C15-C26)

C25

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Malignant neoplasm of pancreas

Malignant neoplasm of pancreas

CMS-HCC V28

N/A

Not mapped

CMS-HCC V24

N/A

Not mapped

ACA/HHS

N/A

Not mapped

ESRD/PACE

N/A

Not mapped

RXHCC

N/A

Not mapped

Code Book Path

Official
C2Malignant neoplasms of digestive organs (C15-C26)
C25Malignant neoplasm of pancreas

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C25 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C25 in this effective period.

Related Child Codes

Official
C25.0Malignant neoplasm of head of pancreas
C25.1Malignant neoplasm of body of pancreas
C25.2Malignant neoplasm of tail of pancreas
C25.3Malignant neoplasm of pancreatic duct
C25.4Malignant neoplasm of endocrine pancreas

Includes

Official

ICD-10-CM does not list Includes notes for C25 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C25 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C25 in this effective period.

Use Additional

Official
  • code to identify:
  • alcohol abuse and dependence (F10.-)

Code Also

Official
  • if applicable exocrine pancreatic insufficiency (K86.81)

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Code
C25
Description
Malignant neoplasm of pancreas
HCC (V28)
No CMS-HCC V28 mapping
RAF
Billable
No
Payment year
2026

Coder workflow notes

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What This Code Means

C25 is the ICD-10-CM diagnosis code for malignant neoplasm of pancreas. C25 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of digestive organs (c15-c26).

Header codes like C25 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at C25's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for C25 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Use Additional Code

  • code to identify:
  • alcohol abuse and dependence (F10.-)

Code Also

  • if applicable exocrine pancreatic insufficiency (K86.81)

Child Codes

Code Hierarchy

C25Malignant neoplasm of pancreas
C25Malignant neoplasm of pancreas

More on C25

Referenced in blog posts

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