C40.02
BillableMalignant neoplasm of scapula and long bones of left upper limb
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C40.02 an HCC code?
Yes. C40.02 maps to Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model (and Lymphoma and Other 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 C40.02
For C40.02to 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 C40.02 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C40.02 is the ICD-10-CM diagnosis code for malignant neoplasm of scapula and long bones of left upper limb. Cancer that starts in the shoulder blade or long bones of the left arm, including the upper arm and forearm bones. C40.02 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of bone and articular cartilage (c40-c41).
Under the CMS-HCC V28 risk adjustment model, C40.02 maps to Lymphoma and Other Cancers (HCC 21) with a community, non-dual, aged base RAF weight of 0.671. Under the older V24 model, C40.02 mapped to the same category but with a base RAF weight of 0.675 — 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.
Confirm left side laterality in documentation; this code is specific to left upper limb involvement. Because C40.02 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 C40.02 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm left side laterality in documentation; this code is specific to left upper limb involvement
- •Document whether the primary site is the scapula or the long bones (humerus, radius, ulna) for complete coding accuracy
Clinical Significance
Primary malignant neoplasm of the scapula and long bones (humerus, radius, ulna) of the left upper limb represents an aggressive bone cancer such as osteosarcoma or chondrosarcoma. These tumors carry significant morbidity due to their potential for metastasis and frequently require surgical resection, chemotherapy, or limb-salvage procedures. Accurate laterality documentation is essential for surgical planning and risk adjustment reporting.
Documentation Requirements
- ✓Explicit left-side laterality documented by the provider
- ✓Specific bone involved (scapula vs. humerus vs. radius vs. ulna)
- ✓Histologic type (osteosarcoma, chondrosarcoma, Ewing sarcoma, etc.)
- ✓Primary vs. metastatic origin confirmed by pathology or imaging
- ✓Current treatment status (active treatment, surveillance, or history of)
- ✓Tumor staging (TNM or Enneking system) if available
Commonly Confused Codes
- •C40.01 — Malignant neoplasm of scapula and long bones of RIGHT upper limb; laterality is the differentiator
- •C40.00 — Malignant neoplasm of scapula and long bones of UNSPECIFIED upper limb; use only when laterality is undocumented
- •C79.51 — Secondary malignant neoplasm of bone; use when cancer has METASTASIZED to bone from another primary site
- •D16.02 — Benign neoplasm of scapula and long bones of left upper limb; confirms benign vs. malignant pathology