C49.A9
BillableGastrointestinal stromal tumor of other sites
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C49.A9 an HCC code?
Yes. C49.A9 maps to Melanoma and Other Skin Cancers 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.A9
For C49.A9 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.A9 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C49.A9 is the ICD-10-CM diagnosis code for gastrointestinal stromal tumor of other sites. A gastrointestinal stromal tumor located in other parts of the digestive system not specified by the more specific codes. C49.A9 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.A9 maps to Melanoma and Other Skin Cancers (HCC 23) with a community, non-dual, aged base RAF weight of 0.251. Under the older CMS-HCC V24 model, C49.A9 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 for GIST in sites such as the stomach, small intestine, or other GI locations. Because C49.A9 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.A9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for GIST in sites such as the stomach, small intestine, or other GI locations
- •Document the specific anatomical site in the medical record for clarity and future reference
Clinical Significance
Gastrointestinal stromal tumor of other sites captures GISTs occurring in uncommon locations such as the mesentery, omentum, or extraintestinal sites. While rare (approximately 5% of GISTs), extra-gastrointestinal GISTs (eGISTs) share the same molecular biology and targeted therapy responsiveness as typical GISTs.
Documentation Requirements
- ✓Pathology confirming GIST with immunohistochemistry at an atypical site
- ✓Specific anatomical site documented (mesentery, omentum, peritoneum, etc.)
- ✓Verification that the site is not better classified under C49.A1-C49.A5
- ✓Tumor size, mitotic rate, and mutation analysis
- ✓Distinction from other soft tissue sarcomas at the same site