C4A.122
BillableMerkel cell carcinoma of left lower eyelid, including canthus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C4A.122 an HCC code?
Yes. C4A.122 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors 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 C4A.122
For C4A.122to 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 C4A.122 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C4A.122 is the ICD-10-CM diagnosis code for merkel cell carcinoma of left lower eyelid, including canthus. This is a rare and aggressive type of skin cancer (Merkel cell carcinoma) that develops on the left lower eyelid, including the corner of the eye where the upper and lower lids meet. It typically appears as a firm, painless nodule and requires prompt treatment. C4A.122 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering melanoma and other malignant neoplasms of skin (c43-c44).
Under the CMS-HCC V28 risk adjustment model, C4A.122 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, C4A.122 maps to Breast, Prostate, and Other Cancers and Tumors (HCC 12) with a community, non-dual, aged base RAF weight of 0.150. 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 laterality (left side) is documented in the medical record before assigning this code, as the sixth character '2' specifically indicates the left lower eyelid. Because C4A.122 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 C4A.122 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify laterality (left side) is documented in the medical record before assigning this code, as the sixth character '2' specifically indicates the left lower eyelid
- •Confirm the histological diagnosis of Merkel cell carcinoma is documented; do not use this code for other eyelid malignancies like basal cell or squamous cell carcinoma
Clinical Significance
Merkel cell carcinoma of the left lower eyelid, including canthus is a rare, highly aggressive neuroendocrine skin malignancy with a high propensity for local recurrence and distant metastasis. Periocular Merkel cell carcinoma requires urgent multidisciplinary management due to the risk of orbital invasion and lymph node spread, and carries a worse prognosis than many other periocular malignancies.
Documentation Requirements
- ✓Histopathologic confirmation of Merkel cell carcinoma (neuroendocrine differentiation on immunohistochemistry — CK20 positive, TTF-1 negative)
- ✓Laterality documented as left side
- ✓Specific eyelid location documented as lower eyelid (not just 'eyelid')
- ✓Tumor size and depth of invasion
- ✓Involvement or sparing of the canthus (medial or lateral corner of the eye)
- ✓Sentinel lymph node biopsy status and results
- ✓Current treatment status (active treatment, surveillance, or recurrence)
Commonly Confused Codes
- •C4A.112 — Merkel cell carcinoma of right lower eyelid; laterality is reversed — always confirm right vs. left from documentation
- •C4A.121 — Merkel cell carcinoma of left upper eyelid; verify whether tumor is on upper or lower eyelid
- •C44.111-C44.122 — Other malignant neoplasms of eyelid skin (basal cell carcinoma, squamous cell carcinoma); Merkel cell carcinoma requires C4A codes, not C44
- •C43.111-C43.122 — Melanoma of eyelid; entirely different histology — melanocytic vs. neuroendocrine origin
- •C69.0x — Malignant neoplasm of conjunctiva; periocular Merkel cell carcinoma involves the skin, not conjunctival mucosa