C25.2
BillableMalignant neoplasm of tail of pancreas
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C25.2 an HCC code?
Yes. C25.2 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 C25.2
For C25.2 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 C25.2 during that encounter — not just copy-forwarded from a problem list.
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 community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, C25.2 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.
Tail cancers may involve the spleen and left kidney, requiring documentation of extent of disease. Because C25.2 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 C25.2 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