C25.1
BillableMalignant neoplasm of body of pancreas
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C25.1 an HCC code?
Yes. C25.1 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
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 C25.1
For C25.1 to 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 C25.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C25.1 is the ICD-10-CM diagnosis code for malignant neoplasm of body of pancreas. Cancer that develops in the body of the pancreas, the middle section of the organ between the head and tail. C25.1 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, C25.1 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, C25.1 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.
Body cancers may be more difficult to detect early as they don't typically cause early symptoms. Because C25.1 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 C25.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Body cancers may be more difficult to detect early as they don't typically cause early symptoms
- •Document the relationship to surrounding structures and vessels for surgical planning
Clinical Significance
Malignant neoplasm of the body of the pancreas carries one of the worst prognoses among pancreatic cancers because these tumors often present at advanced stages due to lack of early symptoms. Unlike head tumors that cause jaundice, body tumors may grow silently until they cause pain or are discovered incidentally. When resectable, treatment involves distal pancreatectomy, but the majority of cases are unresectable at diagnosis due to vascular involvement.
Documentation Requirements
- ✓Documentation confirming body of pancreas as the primary tumor location
- ✓Histological type and grade
- ✓Stage of disease including relationship to major vessels (celiac artery, superior mesenteric artery)
- ✓Resectability assessment
- ✓Cancer antigen 19-9 level and other tumor markers
Commonly Confused Codes
- •C25.0 — Head of pancreas: the head is the wider right portion; the body is the central segment
- •C25.2 — Tail of pancreas: the tail is the narrow left portion near the spleen; the body is between head and tail
- •C25.8 — Overlapping sites of pancreas: use when tumor spans body plus another pancreatic segment
- •C25.9 — Pancreas, unspecified: use C25.1 when body location is documented