C25.2 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 · free HCC coding tools

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 lookupC25.2

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

C25.2

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

Malignant neoplasm of tail of pancreas

Cancer that starts in the tail of the pancreas, the narrow left portion of the organ near the spleen.

Buddy Insight

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 20

Lung and Other Severe Cancers

Coefficient HCC 20: 1.136 (Community Non-Dual Aged (CNA))

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 C25.2Malignant neoplasm of tail of pancreas

Inclusion Terms

Official

No inclusion terms are included in this display for C25.2. 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 C25.1Malignant neoplasm of body 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 C25.2. 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 C25.2. 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 tail of pancreas as the primary tumor location

Histological type (adenocarcinoma, neuroendocrine tumor, acinar cell carcinoma)

Stage of disease including splenic and retroperitoneal involvement

Resectability assessment

MEAT Support

HCC Buddy guidance

Documentation confirming tail of pancreas as the primary tumor location

Histological type (adenocarcinoma, neuroendocrine tumor, acinar cell carcinoma)

Stage of disease including splenic and retroperitoneal involvement

Resectability assessment

Audit Caution

HCC Buddy guidance

Coding tail tumors as body tumors due to imprecise documentation — the tail extends from the body toward the left, typically past the left edge of the vertebral column

Using C25.9 when computed tomography or magnetic resonance imaging clearly identifies a tail mass

Not recognizing that pancreatic neuroendocrine tumors of the tail have a much better prognosis than adenocarcinoma at the same location

Failing to code associated splenectomy complications when splenectomy is performed as part of distal pancreatectomy

Common Mistakes

HCC Buddy guidance

C25.1 — Body of pancreas: the body is the central segment; the tail is the narrow left portion extending toward the spleen

C25.9 — Pancreas, unspecified: use C25.2 when tail location is documented

C25.8 — Overlapping sites: use when the tumor spans the tail into the body or other segments

C7A.1 — Malignant carcinoid tumors of small intestine: neuroendocrine tumors of the pancreatic tail are coded under C25 or C7A.0 depending on type

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 C25.2 an HCC code?

Yes. C25.2 (Malignant neoplasm of tail 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: C25.2 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: C25.2
Description: Malignant neoplasm of tail 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 C25.2 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C25.2

For C25.2, 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

C25.2 is the ICD-10-CM diagnosis code for malignant neoplasm of tail of pancreas. Cancer that starts in the tail of the pancreas, the narrow left portion of the organ near the spleen. C25.2 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, C25.2 maps to Lung and Other Severe Cancers (HCC 20) with a source-labeled community, non-dual, aged reference coefficient of 1.136. 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.

Tail cancers may involve the spleen and left kidney, requiring documentation of extent of disease. For C25.2, 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 C25.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Tail cancers may involve the spleen and left kidney, requiring documentation of extent of disease
•These tumors may present with pain or splenic involvement rather than jaundice

Clinical Significance

Malignant neoplasm of the tail of the pancreas is the least common primary pancreatic cancer location but often presents at the most advanced stage because tail tumors rarely cause bile duct obstruction or early symptoms. These tumors may be discovered only when they invade surrounding structures like the spleen, left kidney, or left adrenal gland, or when they cause abdominal pain from nerve involvement. Distal pancreatectomy with splenectomy is the standard surgical approach when resectable.

Documentation Requirements

✓Documentation confirming tail of pancreas as the primary tumor location
✓Histological type (adenocarcinoma, neuroendocrine tumor, acinar cell carcinoma)
✓Stage of disease including splenic and retroperitoneal involvement
✓Resectability assessment
✓Whether splenectomy is included in the surgical plan

Commonly Confused Codes

•C25.1: Body of pancreas: the body is the central segment; the tail is the narrow left portion extending toward the spleen
•C25.9: Pancreas, unspecified: use C25.2 when tail location is documented
•C25.8: Overlapping sites: use when the tumor spans the tail into the body or other segments
•C7A.1: Malignant carcinoid tumors of small intestine: neuroendocrine tumors of the pancreatic tail are coded under C25 or C7A.0 depending on type