C46.2
BillableKaposi's sarcoma of palate
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C46.2 an HCC code?
Yes. C46.2 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors 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 C46.2
For C46.2 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 C46.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C46.2 is the ICD-10-CM diagnosis code for kaposi's sarcoma of palate. A cancer of blood vessel cells occurring in the roof of the mouth (hard palate), presenting as a visible lesion in the oral cavity. C46.2 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of mesothelial and soft tissue (c45-c49).
Under the CMS-HCC V28 risk adjustment model, C46.2 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors (HCC 21) with a community, non-dual, aged base RAF weight of 0.545. Under the older CMS-HCC V24 model, C46.2 maps to Lymphoma and Other Cancers (HCC 10) with a community, non-dual, aged base RAF weight of 0.675. 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.
Palatal involvement may affect speech, swallowing, or eating; document functional impact and any associated oral complications. Because C46.2 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 C46.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Palatal involvement may affect speech, swallowing, or eating; document functional impact and any associated oral complications
- •Confirm the lesion is in the palate specifically and not in other oral sites (tongue, gums, etc.) which would have different codes
Clinical Significance
Kaposi sarcoma of the palate is a specific oral manifestation that is often the initial presenting sign of Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome. The hard palate is the most common oral site for Kaposi sarcoma and its presence may indicate the need for initiation or optimization of antiretroviral therapy.
Documentation Requirements
- ✓Biopsy-confirmed diagnosis from the palatal lesion
- ✓Specification of hard palate versus soft palate involvement
- ✓Size, color, and morphology of the lesion
- ✓Human Immunodeficiency Virus status, CD4 count, and viral load
- ✓Impact on oral function (eating, speech, swallowing)
Commonly Confused Codes
- •C05.0/C05.1 (Malignant neoplasm of hard/soft palate) — squamous cell carcinoma of palate, not Kaposi sarcoma
- •C46.0 (Kaposi sarcoma of skin) — oral mucosa is not classified as skin; palate has its own code
- •C46.7 (Kaposi sarcoma of other sites) — do not use for palate when C46.2 exists
- •D10.6 (Benign neoplasm of nasopharynx) — benign and different anatomical location