What is ICD-10 code C49.5?

C49.5 is the ICD-10-CM diagnosis code for Malignant neoplasm of connective and soft tissue of pelvis. A malignant (cancerous) tumor that develops in the connective tissues and soft tissues of the pelvis, such as muscles, fat, or fibrous tissue in that region. C49.5 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C49.5 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. C49.5 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. C49.5 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.

Which HCC does C49.5 map to under V28?

C49.5 maps to CMS-HCC V28 21 (Lymphoma and Other Cancers). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does C49.5 pay in RAF?

C49.5 carries a community, non-dual, aged (CNA) RAF weight of 0.671 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for C49.5?

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 C49.5, V28 maps to Lymphoma and Other Cancers at RAF 0.671 while V24 mapped to Lymphoma and Other Cancers at RAF 0.675. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM C49.5: Malignant neoplasm

C49.5 maps to CMS-HCC V28 21 (RAF 0.671). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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Code lookupC49.5Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of mesothelial and soft tissue (C45-C49)

C49.5

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

Malignant neoplasm of connective and soft tissue of pelvis

A malignant (cancerous) tumor that develops in the connective tissues and soft tissues of the pelvis, such as muscles, fat, or fibrous tissue in that region.

Buddy Insight

Malignant neoplasm of connective and soft tissue of the pelvis represents pelvic sarcomas arising from non-organ soft tissue structures.

CMS-HCC V28

Mapped

HCC 21

Lymphoma and Other Cancers

RAF 0.671

CMS-HCC V24

Mapped

HCC 10

Lymphoma and Other Cancers

RAF 0.675

ACA/HHS

Mapped

HCC 10

HHS-HCC 10

Varies by metal level

ESRD/PACE

Mapped

HCC 10

Lymphoma and Other Cancers

RAF 0.111

RXHCC

Mapped

HCC 22

Cancer, Other Specified Sites

RAF 0.124

Code Book Path

Official

C49Malignant neoplasm of other connective and soft tissue

C49.5Malignant neoplasm of connective and soft tissue of pelvis

Inclusion Terms

Official

Malignant neoplasm of buttock
Malignant neoplasm of groin
Malignant neoplasm of perineum

Excludes 2

Official

Kaposi's sarcoma of soft tissue (C46.1)
malignant neoplasm of heart (C38.0)
malignant neoplasm of peripheral nerves and autonomic nervous system (C47.-)
malignant neoplasm of peritoneum (C48.2)
malignant neoplasm of retroperitoneum (C48.0)

Related Child Codes

Official

C49.0Malignant neoplasm of connective and soft tissue of head, face and neck

C49.1Malignant neoplasm of connective and soft tissue of upper limb, including shoulder

C49.2Malignant neoplasm of connective and soft tissue of lower limb, including hip

C49.3Malignant neoplasm of connective and soft tissue of thorax

C49.4Malignant neoplasm of connective and soft tissue of abdomen

Includes

Official

malignant neoplasm of blood vessel
malignant neoplasm of bursa
malignant neoplasm of cartilage
malignant neoplasm of fascia
malignant neoplasm of fat

Excludes 1

Official

malignant neoplasm of cartilage (of):
articular (C40-C41)
larynx (C32.3)
nose (C30.0)
malignant neoplasm of connective tissue of breast (C50.-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C49.5 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C49.5 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C49.5 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Pathology confirming malignant soft tissue neoplasm within the pelvis

Distinction from primary pelvic organ malignancies (uterine, bladder, rectal, ovarian)

Specific pelvic location and relationship to pelvic organs

Histological subtype and tumor grade

MEAT Support

HCC Buddy guidance

Pathology confirming malignant soft tissue neoplasm within the pelvis

Distinction from primary pelvic organ malignancies (uterine, bladder, rectal, ovarian)

Specific pelvic location and relationship to pelvic organs

Histological subtype and tumor grade

Audit Caution

HCC Buddy guidance

Confusing pelvic soft tissue sarcomas with primary pelvic organ cancers (uterine, bladder, rectal)

Using the ill-defined site code C76.3 when soft tissue origin is confirmed on pathology

Not distinguishing nerve sheath tumors (C47.5) from general soft tissue sarcomas (C49.5)

Coding metastatic pelvic disease as a primary pelvic soft tissue malignancy

Common Mistakes

HCC Buddy guidance

C47.5 (Peripheral nerves of pelvis) — nerve-origin pelvic tumor

C48.1 (Specified parts of peritoneum) — peritoneal malignancy, not soft tissue

C76.3 (Malignant neoplasm of pelvis) — ill-defined pelvic site malignancy

C54-C55 (Malignant neoplasm of uterus) — primary uterine malignancy, not pelvic soft tissue

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 C49.5 an HCC code?

Yes. C49.5 (Malignant neoplasm of connective and soft tissue of pelvis) maps to Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model (and Lymphoma and Other Cancers under V24), with a community non-dual aged RAF of 0.671. It is billable for payment year 2026.

Coder answer: C49.5 is billable and maps to V28 HCC 21, Lymphoma and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: C49.5
Description: Malignant neoplasm of connective and soft tissue of pelvis
HCC (V28): HCC 21 — Lymphoma and Other Cancers
RAF: 0.671
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 21, Lymphoma and Other Cancers

0.671

V24HCC 10, Lymphoma and Other Cancers

0.675

ESRDHCC 10, Lymphoma and Other Cancers

0.111

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 C49.5 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for C49.5

For C49.5 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 C49.5 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

C49.5 is the ICD-10-CM diagnosis code for malignant neoplasm of connective and soft tissue of pelvis. A malignant (cancerous) tumor that develops in the connective tissues and soft tissues of the pelvis, such as muscles, fat, or fibrous tissue in that region. C49.5 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, C49.5 maps to Lymphoma and Other Cancers (HCC 21) with a community, non-dual, aged base RAF weight of 0.671. Under the older V24 model, C49.5 mapped to the same category but with a base RAF weight of 0.675, V28 recalibrated weights across the entire model. 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 exact anatomical site within the pelvis is documented to ensure accurate coding. Because C49.5 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 C49.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify the exact anatomical site within the pelvis is documented to ensure accurate coding
•Confirm malignancy status and obtain histology type when available for complete documentation

Clinical Significance

Malignant neoplasm of connective and soft tissue of the pelvis represents pelvic sarcomas arising from non-organ soft tissue structures. These deep-seated tumors are surgically challenging due to proximity to vital pelvic organs, major vessels, and nerves, often requiring multidisciplinary surgical teams.

Documentation Requirements

✓Pathology confirming malignant soft tissue neoplasm within the pelvis
✓Distinction from primary pelvic organ malignancies (uterine, bladder, rectal, ovarian)
✓Specific pelvic location and relationship to pelvic organs
✓Histological subtype and tumor grade
✓MRI pelvis showing tumor boundaries and organ involvement

Commonly Confused Codes

•C47.5 (Peripheral nerves of pelvis): nerve-origin pelvic tumor
•C48.1 (Specified parts of peritoneum): peritoneal malignancy, not soft tissue
•C76.3 (Malignant neoplasm of pelvis): ill-defined pelvic site malignancy
•C54-C55 (Malignant neoplasm of uterus): primary uterine malignancy, not pelvic soft tissue