What is ICD-10 code C25.1?

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. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C25.1 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C25.1 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. C25.1 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. C25.1 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.

Which HCC does C25.1 map to under V28?

C25.1 maps to CMS-HCC V28 HCC 20 (Lung and Other Severe Cancers). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM C25.1: Malignant neoplasm of body

C25.1 maps to CMS-HCC V28 20. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

ICD-10-CM Code View

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Code lookupC25.1

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

C25.1

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

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.

Buddy Insight

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.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 20

Lung and Other Severe Cancers

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 009

HHS-HCC 009 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 9

Lung and Other Severe Cancers

Code-level coefficient reference

RXHCC

Mapped

HCC 20

Lung, Kidney, and Other Cance...

Code-level coefficient reference

Code Book Path

Official

C25Malignant neoplasm of pancreas C25.1Malignant neoplasm of body of pancreas

Inclusion Terms

Official

No inclusion terms are included in this display for C25.1. Check the code and parent instructions in the Code Book.

Excludes 2

Official

gastrointestinal stromal tumors (C49.A-)Inherited from C15-C26

Related Codes

Official

C25.0Malignant neoplasm of head 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

No Includes notes are included in this display for C25.1. Check the code and parent instructions in the Code Book.

Excludes 1

Official

Kaposi's sarcoma of gastrointestinal sites (C46.4)Inherited from C15-C26

Code First

Official

No Code First sequencing instructions are included in this display for C25.1. Check the code and parent instructions in the Code Book.

Use Additional

Official

code to identify:Inherited from C25
alcohol abuse and dependence (F10.-)Inherited from C25

Code Also

Official

if applicable exocrine pancreatic insufficiency (K86.81)Inherited from C25

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Defaulting to C25.9 when cross-sectional imaging clearly shows a body tumor

Confusing body and tail locations — the body is the central portion, the tail extends to the left near the spleen

Not recognizing that body tumors may involve major vascular structures, making resectability the key clinical question

Coding a body tumor as head when the imaging shows the mass centered in the mid-pancreas

Common Mistakes

HCC Buddy guidance

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

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 →

Is C25.1 an HCC code?

Yes. C25.1 (Malignant neoplasm of body of pancreas) maps to HCC 20, Lung and Other Severe Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 1.136. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: C25.1 is billable and maps to V28 HCC 20, Lung and Other Severe Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: C25.1
Description: Malignant neoplasm of body of pancreas
HCC (V28): HCC 20 — Lung and Other Severe Cancers
RAF reference coefficient: 1.136
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 20, Lung and Other Severe Cancers

1.136

ESRDHCC 9, Lung and Other Severe Cancers

Not separately weighted

RxHCCHCC 20, Lung, Kidney, and Other Cancers; Secondary Cancer of Lymph Nodes and Other Sites

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work C25.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C25.1

For C25.1, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

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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 source-labeled community, non-dual, aged reference coefficient of 1.136. No V24 mapping is shown for C25.1; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Body cancers may be more difficult to detect early as they don't typically cause early symptoms. For C25.1, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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