What is ICD-10 code C25.0?

C25.0 is the ICD-10-CM diagnosis code for Malignant neoplasm of head of pancreas. Cancer that starts in the head of the pancreas, the wider portion on the right side of the organ that connects to the small intestine. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C25.0 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C25.0 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. C25.0 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. C25.0 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for C25.0?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For C25.0, V28 maps to Lung and Other Severe Cancers at RAF 0.000 while V24 mapped to Lung and Other Severe Cancers at RAF 0.973. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting C25.0?

Pancreatic head cancers often present late due to location and may cause jaundice and bile duct obstruction Distinguish from body (C25.1) and tail (C25.2) cancers which have different prognoses and treatment approaches Because C25.0 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

C25.0 ICD-10 Code: Malignant neoplasm of head

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupC25.0Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

C25.0

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Malignant neoplasm of head of pancreas

Cancer that starts in the head of the pancreas, the wider portion on the right side of the organ that connects to the small intestine.

Buddy Insight

Malignant neoplasm of the head of the pancreas is the most common location for pancreatic cancer, accounting for approximately 60-70% of all pancreatic adenocarcinomas.

CMS-HCC V28

Mapped

HCC 20

Lung and Other Severe Cancers

RAF 0.0

CMS-HCC V24

Mapped

HCC 9

Lung and Other Severe Cancers

RAF 0.973

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 9

Lung and Other Severe Cancers

RAF 0.0

RXHCC

Mapped

HCC 20

Cancer, Liver and Intrahepati...

RAF 0.0

Code Trumping

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Compare selected patient codes to show trumped or trumps impact.

Code Book Path

Official

C25Malignant neoplasm of pancreas

C25.0Malignant neoplasm of head of pancreas

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C25.0 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C25.0 in this effective period.

Related Child Codes

Official

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

C25.7Malignant neoplasm of other parts of pancreas

Includes

Official

ICD-10-CM does not list Includes notes for C25.0 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C25.0 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C25.0 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)

Buddy Documentation Tip

HCC Buddy guidance

Documentation confirming head of pancreas as the primary tumor location

Histological type (ductal adenocarcinoma is most common; also neuroendocrine, acinar cell, etc.)

Stage of disease including vascular involvement (superior mesenteric artery, portal vein)

Resectability assessment (resectable, borderline resectable, or locally advanced/unresectable)

MEAT Support

HCC Buddy guidance

Documentation confirming head of pancreas as the primary tumor location

Histological type (ductal adenocarcinoma is most common; also neuroendocrine, acinar cell, etc.)

Stage of disease including vascular involvement (superior mesenteric artery, portal vein)

Resectability assessment (resectable, borderline resectable, or locally advanced/unresectable)

Audit Caution

HCC Buddy guidance

Coding periampullary cancer as pancreatic head cancer when the primary site is actually the ampulla (C24.1) — ampullary cancer has a significantly better prognosis

Using C25.9 (unspecified) when imaging or surgical documentation clearly identifies the head

Not recognizing that 'uncinate process' tumors are part of the pancreatic head and coded as C25.0

Confusing neuroendocrine tumors of the pancreatic head (which may have separate codes in C25 or C7A) with adenocarcinoma

Common Mistakes

HCC Buddy guidance

C24.1 — Ampulla of Vater: periampullary cancers include both pancreatic head and ampullary tumors; the primary site determines the code and prognosis

C25.1 — Body of pancreas: the body is the middle segment; head is the widest portion adjacent to the duodenum

C25.9 — Pancreas, unspecified: use C25.0 when head location is documented

C17.0 — Duodenum: pancreatic head tumors may invade the duodenum; code the primary site

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is C25.0 an HCC code?

Yes. C25.0 maps to Lung and Other Severe Cancers under the CMS-HCC V28 risk adjustment model (and Lung and Other Severe Cancers under V24).

HCC Category Mapping

V28HCC 20, Lung and Other Severe Cancers

0.000

V24HCC 9, Lung and Other Severe Cancers

0.973

ESRDHCC 9, Lung and Other Severe Cancers

0.000

RxHCCHCC 20, Cancer, Liver and Intrahepatic Bile Duct

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for C25.0

For C25.0to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed C25.0 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

C25.0 is the ICD-10-CM diagnosis code for malignant neoplasm of head of pancreas. Cancer that starts in the head of the pancreas, the wider portion on the right side of the organ that connects to the small intestine. C25.0 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of digestive organs (c15-c26).

Under the CMS-HCC V28 risk adjustment model, C25.0 maps to Lung and Other Severe Cancers (HCC 20) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, C25.0 mapped to the same category but with a base RAF weight of 0.973, V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Pancreatic head cancers often present late due to location and may cause jaundice and bile duct obstruction. Because C25.0 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for C25.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Pancreatic head cancers often present late due to location and may cause jaundice and bile duct obstruction
•Distinguish from body (C25.1) and tail (C25.2) cancers which have different prognoses and treatment approaches

Clinical Significance

Malignant neoplasm of the head of the pancreas is the most common location for pancreatic cancer, accounting for approximately 60-70% of all pancreatic adenocarcinomas. Pancreatic head tumors often present with painless jaundice due to bile duct compression, which may allow for slightly earlier detection compared to body and tail tumors. The standard surgical treatment is pancreaticoduodenectomy (Whipple procedure), one of the most complex and resource-intensive operations in abdominal surgery.

Documentation Requirements

✓Documentation confirming head of pancreas as the primary tumor location
✓Histological type (ductal adenocarcinoma is most common; also neuroendocrine, acinar cell, etc.)
✓Stage of disease including vascular involvement (superior mesenteric artery, portal vein)
✓Resectability assessment (resectable, borderline resectable, or locally advanced/unresectable)
✓Cancer antigen 19-9 and other tumor marker levels

Commonly Confused Codes

•C24.1 — Ampulla of Vater: periampullary cancers include both pancreatic head and ampullary tumors; the primary site determines the code and prognosis
•C25.1 — Body of pancreas: the body is the middle segment; head is the widest portion adjacent to the duodenum
•C25.9 — Pancreas, unspecified: use C25.0 when head location is documented
•C17.0 — Duodenum: pancreatic head tumors may invade the duodenum; code the primary site