C49.11
BillableMalignant neoplasm of connective and soft tissue of right upper limb, including shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C49.11 an HCC code?
Yes. C49.11 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 C49.11
For C49.11 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 C49.11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C49.11 is the ICD-10-CM diagnosis code for malignant neoplasm of connective and soft tissue of right upper limb, including shoulder. This code describes cancer that has started in the soft tissues (muscles, fat, nerves, or blood vessels) of the right arm or shoulder area. It is a malignant tumor, meaning it is cancerous and can spread to other parts of the body. C49.11 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, C49.11 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, C49.11 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.
Verify the laterality is documented as right upper limb; if left or bilateral, use different codes (C49.12 for left, C49.13 for bilateral). Because C49.11 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 C49.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the laterality is documented as right upper limb; if left or bilateral, use different codes (C49.12 for left, C49.13 for bilateral)
- •Ensure the neoplasm is confirmed as malignant and originates in connective/soft tissue rather than bone (which would use different C-codes); review pathology reports for confirmation
Clinical Significance
Malignant neoplasm of connective and soft tissue of the right upper limb including shoulder. This laterality-specific code captures sarcomas such as liposarcoma, undifferentiated pleomorphic sarcoma, and synovial sarcoma of the right arm/shoulder region, supporting accurate disease tracking and treatment planning.
Documentation Requirements
- ✓Right-sided laterality explicitly documented
- ✓Pathology confirming malignant soft tissue neoplasm with histological subtype
- ✓Specific location within the right upper limb
- ✓Tumor stage, grade, and size
- ✓Surgical margins if resected and functional outcome assessment