C41.1 ICD-10-CM Code: Malignant neoplasm of mandible
C41.1 maps to CMS-HCC V28 21. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of bone and articular cartilage (C40-C41)
C41.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMalignant neoplasm of mandible
Cancer that starts in the lower jawbone (mandible).
Buddy Insight
Primary malignant neoplasm of the mandible (lower jawbone).
CMS-HCC V28
MappedHCC 21
Coefficient HCC 21: 0.671 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 010
Code-level coefficient reference
ESRD/PACE
MappedHCC 10
Code-level coefficient reference
RXHCC
MappedHCC 22
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Malignant neoplasm of inferior maxilla
- Malignant neoplasm of lower jaw bone
Excludes 2
Official- carcinoma, any type except intraosseous or odontogenic of:
- jaw NOS (C03.9)
- lower (C03.1)
- malignant neoplasm of upper jaw bone (C41.0)
Related Codes
Includes
Official- malignant neoplasm of cartilage (articular) (joint)Inherited from C40-C41
- malignant neoplasm of periosteumInherited from C40-C41
Excludes 1
Official- malignant neoplasm of bone marrow NOS (C96.9)Inherited from C40-C41, C41
- malignant neoplasm of synovia (C49.-)Inherited from C40-C41, C41
- malignant neoplasm of bones of limbs (C40.-)Inherited from C40-C41, C41
- malignant neoplasm of cartilage of ear (C49.0)Inherited from C40-C41, C41
- malignant neoplasm of cartilage of eyelid (C49.0)Inherited from C40-C41, C41
- malignant neoplasm of cartilage of larynx (C32.3)Inherited from C40-C41, C41
- malignant neoplasm of cartilage of limbs (C40.-)Inherited from C40-C41, C41
- malignant neoplasm of cartilage of nose (C30.0)Inherited from C40-C41, C41
Code First
OfficialNo Code First sequencing instructions are included in this display for C41.1. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for C41.1. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for C41.1. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 C41.1 an HCC code?
Yes. C41.1 (Malignant neoplasm of mandible) maps to HCC 21, Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.671. 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: C41.1 is billable and maps to V28 HCC 21, Lymphoma and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- C41.1
- Description
- Malignant neoplasm of mandible
- HCC (V28)
- HCC 21 — Lymphoma and Other Cancers
- RAF reference coefficient
- 0.671
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 C41.1 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for C41.1
For C41.1, 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
C41.1 is the ICD-10-CM diagnosis code for malignant neoplasm of mandible. Cancer that starts in the lower jawbone (mandible). C41.1 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, C41.1 maps to Lymphoma and Other Cancers (HCC 21) with a source-labeled community, non-dual, aged reference coefficient of 0.671. 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.
The mandible is the lower jaw; do not confuse with maxilla (upper jaw) which has different codes. For C41.1, 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 C41.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The mandible is the lower jaw; do not confuse with maxilla (upper jaw) which has different codes
- •Document whether the cancer is primary to the bone or metastatic from another site
Clinical Significance
Primary malignant neoplasm of the mandible (lower jawbone). This includes osteosarcoma, ameloblastic carcinoma, and other primary malignancies of the mandibular bone. The mandible is a unique coding site because it is separated from other skull and facial bones. These cancers often require extensive surgical resection affecting speech, swallowing, and facial aesthetics.
Documentation Requirements
- ✓Confirmation the tumor originates in the mandibular bone, not the overlying gingiva (gum) or floor of mouth mucosa
- ✓Histologic type from pathology (osteosarcoma, ameloblastic carcinoma, squamous cell carcinoma with bone invasion)
- ✓Primary vs. metastatic origin documented
- ✓Extent of bony involvement documented by imaging
- ✓Treatment plan including surgical resection and reconstruction approach
- ✓Involvement of adjacent structures (teeth, gingiva, floor of mouth, mental nerve)
Excludes 2, Not included here, may code separately
Commonly Confused Codes
- •C41.0: Malignant neoplasm of bones of skull and face; covers all other skull/facial bones EXCEPT mandible
- •C03.1: Malignant neoplasm of lower gum; gingival cancer is mucosal, not bone origin
- •C04.x: Malignant neoplasm of floor of mouth; floor of mouth cancers may invade mandible but originate in mucosa
- •C06.x: Malignant neoplasm of other parts of mouth; mucosal oral cancers vs. bone origin