C43.52 ICD-10-CM Code: Malignant melanoma of skin of breast
C43.52 maps to CMS-HCC V28 23 (RAF 0.186). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Neoplasms (C00-D49) / Melanoma and other malignant neoplasms of skin (C43-C44)
C43.52
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMalignant melanoma of skin of breast
A type of skin cancer (melanoma) that develops on the skin of the breast area. This aggressive cancer requires immediate medical attention and treatment.
Buddy Insight
Malignant melanoma of the skin of the breast.
CMS-HCC V28
MappedHCC 23
RAF 0.186
CMS-HCC V24
MappedHCC 12
RAF 0.150
ACA/HHS
MappedHCC 13
Varies by metal level
ESRD/PACE
MappedHCC 12
RAF 0.045
RXHCC
MappedHCC 22
RAF 0.124
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for C43.52 in this effective period.
Excludes 2
Official- malignant neoplasm of anus NOS (C21.0)
- malignant neoplasm of scrotum (C63.2)
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for C43.52 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for C43.52 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for C43.52 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for C43.52 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for C43.52 in this effective period.
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 C43.52 an HCC code?
Yes. C43.52 (Malignant melanoma of skin of breast) maps to Prostate, Breast, and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors under V24), with a community non-dual aged RAF of 0.186. It is billable for payment year 2026.
Coder answer: C43.52 is billable and maps to V28 HCC 23, Prostate, Breast, and Other Cancers and Tumors. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- C43.52
- Description
- Malignant melanoma of skin of breast
- HCC (V28)
- HCC 23 — Prostate, Breast, and Other Cancers and Tumors
- RAF
- 0.186
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 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.
Work C43.52 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for C43.52
For C43.52 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 C43.52 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
C43.52 is the ICD-10-CM diagnosis code for malignant melanoma of skin of breast. A type of skin cancer (melanoma) that develops on the skin of the breast area. This aggressive cancer requires immediate medical attention and treatment. C43.52 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering melanoma and other malignant neoplasms of skin (c43-c44).
Under the CMS-HCC V28 risk adjustment model, C43.52 maps to Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a community, non-dual, aged base RAF weight of 0.186. Under the older CMS-HCC V24 model, C43.52 maps to Breast, Prostate, and Other Cancers and Tumors (HCC 12) with a community, non-dual, aged base RAF weight of 0.150. 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 documentation specifies skin of breast rather than breast tissue itself. Because C43.52 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 C43.52 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm documentation specifies skin of breast rather than breast tissue itself
- •Consider laterality (right vs. left breast) if documented, though this code does not differentiate
Clinical Significance
Malignant melanoma of the skin of the breast. This refers to melanoma arising from the cutaneous surface of the breast, not breast carcinoma. Breast skin melanoma follows the same principles as other cutaneous melanomas and should not be confused with ductal or lobular breast cancer. It is more common in sun-exposed upper chest areas.
Documentation Requirements
- ✓Confirmation the melanoma arises from the breast SKIN, not breast parenchyma
- ✓Laterality (right vs. left breast skin) if documented
- ✓Breslow depth and ulceration status
- ✓Sentinel lymph node biopsy results (axillary nodes for breast skin)
- ✓AJCC melanoma staging (NOT breast cancer staging)
- ✓Treatment plan (wide excision, sentinel lymph node biopsy)
Commonly Confused Codes
- •C50.x: Malignant neoplasm of breast; for ductal, lobular, and other breast PARENCHYMAL cancers: completely different disease
- •C43.59: Melanoma of other part of trunk; if the melanoma is on adjacent chest wall skin rather than the breast skin specifically
- •C43.51: Melanoma of anal skin; different trunk site
- •C44.521: Squamous cell carcinoma of skin of breast; different histology, same site