What is ICD-10 code C43.60?

C43.60 is the ICD-10-CM diagnosis code for Malignant melanoma of unspecified upper limb, including shoulder. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C43.60 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C43.60 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. C43.60 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. C43.60 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for C43.60?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For C43.60, V28 maps to Prostate, Breast, and Other Cancers and Tumors at RAF 0.186 while V24 mapped to Breast, Prostate, and Other Cancers and Tumors at RAF 0.150. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting C43.60?

Use this code only when laterality cannot be determined from documentation Query the provider if laterality is documented elsewhere in the record to assign C43.61 or C43.62 Because C43.60 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM C43.60: Malignant melanoma

ICD-10-CM Code View

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Code lookupC43.60Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Melanoma and other malignant neoplasms of skin (C43-C44)

C43.60

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

Malignant melanoma of unspecified upper limb, including shoulder

A type of skin cancer (melanoma) that develops on the upper arm, forearm, hand, or shoulder area, but the specific side (right or left) is not documented. This serious cancer requires prompt treatment.

Buddy Insight

Malignant melanoma of an unspecified upper limb, including the shoulder, with unspecified laterality.

CMS-HCC V28

Mapped

HCC 23

Prostate, Breast, and Other C...

RAF 0.186

CMS-HCC V24

Mapped

HCC 12

Breast, Prostate, and Other C...

RAF 0.150

ACA/HHS

Mapped

HCC 13

HHS-HCC 13

Varies by metal level

ESRD/PACE

Mapped

HCC 12

Breast, Prostate, and Other C...

RAF 0.045

RXHCC

Mapped

HCC 22

Cancer, Other Specified Sites

RAF 0.124

Code Book Path

Official

C43Malignant melanoma of skin

C43.6Malignant melanoma of upper limb, including shoulder

C43.60Malignant melanoma of unspecified upper limb, including shoulder

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C43.60 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C43.60 in this effective period.

Related Child Codes

Official

C43.61Malignant melanoma of right upper limb, including shoulder

C43.62Malignant melanoma of left upper limb, including shoulder

Includes

Official

ICD-10-CM does not list Includes notes for C43.60 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C43.60 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C43.60 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C43.60 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C43.60 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Attempt to clarify laterality (right vs. left) and specific upper limb site

Breslow depth and ulceration status

Sentinel lymph node biopsy results (axillary or epitrochlear nodes)

AJCC staging and mitotic rate

MEAT Support

HCC Buddy guidance

Attempt to clarify laterality (right vs. left) and specific upper limb site

Breslow depth and ulceration status

Sentinel lymph node biopsy results (axillary or epitrochlear nodes)

AJCC staging and mitotic rate

Audit Caution

HCC Buddy guidance

Using unspecified laterality when the medical record documents which arm is affected

Confusing shoulder melanoma between upper limb (C43.6x) and trunk (C43.59) classification

Coding melanoma in situ as invasive melanoma

Not querying for laterality when it should be readily available from the excision report

Common Mistakes

HCC Buddy guidance

C43.61 — Melanoma of RIGHT upper limb; use when right is documented

C43.62 — Melanoma of LEFT upper limb; use when left is documented

C43.59 — Melanoma of trunk; boundary at the shoulder can be ambiguous

D03.60 — Melanoma in situ of unspecified upper limb; non-invasive, no HCC

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 C43.60 an HCC code?

Yes. C43.60 (Malignant melanoma of unspecified upper limb, including shoulder) 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: C43.60 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: C43.60
Description: Malignant melanoma of unspecified upper limb, including shoulder
HCC (V28): HCC 23 — Prostate, Breast, and Other Cancers and Tumors
RAF: 0.186
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 23, Prostate, Breast, and Other Cancers and Tumors

0.186

V24HCC 12, Breast, Prostate, and Other Cancers and Tumors

0.150

ESRDHCC 12, Breast, Prostate, and Other Cancers and Tumors

0.045

RxHCCHCC 22, Cancer, Other Specified Sites

0.124

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 C43.60 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for C43.60

For C43.60 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 C43.60 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

C43.60 is the ICD-10-CM diagnosis code for malignant melanoma of unspecified upper limb, including shoulder. A type of skin cancer (melanoma) that develops on the upper arm, forearm, hand, or shoulder area, but the specific side (right or left) is not documented. This serious cancer requires prompt treatment. C43.60 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, C43.60 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, C43.60 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.

Use this code only when laterality cannot be determined from documentation. Because C43.60 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 C43.60 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only when laterality cannot be determined from documentation
•Query the provider if laterality is documented elsewhere in the record to assign C43.61 or C43.62

Clinical Significance

Malignant melanoma of an unspecified upper limb, including the shoulder, with unspecified laterality. Upper extremity melanoma is common, particularly on the forearms and dorsal hands due to sun exposure. The unspecified laterality should prompt a provider query, as it represents a documentation gap.