C47.20
BillableMalignant neoplasm of peripheral nerves of unspecified lower limb, including hip
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C47.20 an HCC code?
Yes. C47.20 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 C47.20
For C47.20 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 C47.20 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C47.20 is the ICD-10-CM diagnosis code for malignant neoplasm of peripheral nerves of unspecified lower limb, including hip. A malignant tumor of the peripheral nerves in the lower leg or hip area, but the specific side (left or right) is not identified. C47.20 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, C47.20 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, C47.20 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.
Use this code only when laterality is not specified; if documented, use the appropriate laterality-specific code. Because C47.20 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 C47.20 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 is not specified; if documented, use the appropriate laterality-specific code.
- •This code includes the entire lower limb from hip to toes.
Clinical Significance
Malignant neoplasm of peripheral nerves of the lower limb (including hip) without laterality specification. These tumors frequently arise from the sciatic nerve or its branches and can cause significant pain, weakness, and functional limitation. Laterality should be queried when not documented.
Documentation Requirements
- ✓Pathology confirming malignant peripheral nerve tumor
- ✓Laterality (right or left) — query if not documented
- ✓Specific nerve involved (sciatic, femoral, tibial, peroneal, etc.)
- ✓Tumor size and relationship to neurovascular bundle
- ✓Functional impact including gait abnormalities or neurological deficits
Commonly Confused Codes
- •C47.21/C47.22 (Right/left lower limb peripheral nerve malignancy) — use when laterality is known
- •C49.20 (Malignant neoplasm of connective/soft tissue of unspecified lower limb) — soft tissue origin
- •D36.13 (Benign neoplasm of peripheral nerves of lower limb) — benign nerve tumors
- •C47.5 (Malignant neoplasm of peripheral nerves of pelvis) — if the tumor is pelvic rather than lower limb