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C50.011 ICD-10-CM Code: Malignant neoplasm of nipple and areola, right female breast

C50.011 maps to CMS-HCC V28 23. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupC50.011

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of breast (C50)

C50.011

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

Malignant neoplasm of nipple and areola, right female breast

Breast cancer that starts in the nipple or the dark area around the nipple (areola) on the right breast in a female patient.

Buddy the Bee presenting code insight

Buddy Insight

Malignant neoplasm of the nipple and areola, right female breast represents invasive breast cancer requiring staging, treatment planning, and ongoing surveillance.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 23

Coefficient HCC 23: 0.186 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

Context needed

HCC 011, HCC 012

Coefficient needs member context

ESRD/PACE

Context needed

HCC 12

Coefficient needs member context

RXHCC

HCC 22

Code-level coefficient reference

Code Book Path

Official
C50.0Malignant neoplasm of nipple and areolaC50.01Malignant neoplasm of nipple and areola, femaleC50.011Malignant neoplasm of nipple and areola, right female breast

Inclusion Terms

Official

No inclusion terms are included in this display for C50.011. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for C50.011. Check the code and parent instructions in the Code Book.

Related Codes

Official
C50.012Malignant neoplasm of nipple and areola, left female breastC50.019Malignant neoplasm of nipple and areola, unspecified female breast

Includes

Official
  • connective tissue of breastInherited from C50
  • Paget's disease of breastInherited from C50
  • Paget's disease of nippleInherited from C50

Excludes 1

Official
  • skin of breast (C44.501, C44.511, C44.521, C44.591)Inherited from C50

Code First

Official

No Code First sequencing instructions are included in this display for C50.011. Check the code and parent instructions in the Code Book.

Use Additional

Official
  • code to identify estrogen, and other hormones and factors receptor status (Z17.-)Inherited from C50

Code Also

Official

No Code Also instructions are included in this display for C50.011. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Pathologic confirmation of malignancy — distinguish Paget disease of nipple from invasive carcinoma with nipple involvement
Laterality: right breast
Gender documented as female to support gender-specific code selection
Quadrant or subsite location: nipple and areola

MEAT Support

HCC Buddy guidance
Pathologic confirmation of malignancy — distinguish Paget disease of nipple from invasive carcinoma with nipple involvement
Laterality: right breast
Gender documented as female to support gender-specific code selection
Quadrant or subsite location: nipple and areola

Audit Caution

HCC Buddy guidance
Confusing nipple/areola (C50.0x) with central portion (C50.1x) — nipple/areola is the nipple-areolar complex specifically
Not distinguishing Paget disease of the nipple (which IS coded here) from invasive carcinoma extending to the nipple
Selecting wrong gender code — C50.01x is female, C50.02x is male
Coding carcinoma in situ (D05.x) as invasive carcinoma (C50.x) — these are fundamentally different stages

Common Mistakes

HCC Buddy guidance
C50.012 — Left female breast nipple/areola; verify laterality
C50.019 — Unspecified female breast; use only when laterality cannot be determined
C50.021 — Same laterality but male breast; verify patient gender
C50.111-C50.119 — Central portion of female breast; central portion is distinct from nipple/areola

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 C50.011 an HCC code?

Yes. C50.011 (Malignant neoplasm of nipple and areola, right female breast) maps to HCC 23, Prostate, Breast, and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.186. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: C50.011 is billable and maps to V28 HCC 23, Prostate, Breast, and Other Cancers and Tumors. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
C50.011
Description
Malignant neoplasm of nipple and areola, right female breast
HCC (V28)
HCC 23 — Prostate, Breast, and Other Cancers and Tumors
RAF reference coefficient
0.186
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 23, Prostate, Breast, and Other Cancers and Tumors
0.186
RxHCCHCC 22, Prostate, Breast, Bladder, and Other Cancers and Tumors
Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work C50.011 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C50.011

For C50.011, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

  • 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

Coder workflow notes

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What This Code Means

C50.011 is the ICD-10-CM diagnosis code for malignant neoplasm of nipple and areola, right female breast. Breast cancer that starts in the nipple or the dark area around the nipple (areola) on the right breast in a female patient. C50.011 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of breast (c50).

Under the CMS-HCC V28 risk adjustment model, C50.011 maps to Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a source-labeled community, non-dual, aged reference coefficient of 0.186. No V24 mapping is shown for C50.011; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Malignant neoplasm of nipple and areola, right female breast, Paget disease or NAC primary on the right. For C50.011, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for C50.011 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Malignant neoplasm of nipple and areola, right female breast, Paget disease or NAC primary on the right.
  • •The C50 family uses sub-site specificity, central portion, upper-outer, lower-outer, etc. Ensure the pathology report's described location matches the assigned sub-site code.

Clinical Significance

Malignant neoplasm of the nipple and areola, right female breast represents invasive breast cancer requiring staging, treatment planning, and ongoing surveillance. Breast cancer is risk-adjusted because it demands significant healthcare resources including surgery, radiation, chemotherapy, hormonal therapy, and long-term monitoring.

Documentation Requirements

  • ✓Pathologic confirmation of malignancy — distinguish Paget disease of nipple from invasive carcinoma with nipple involvement
  • ✓Laterality: right breast
  • ✓Gender documented as female to support gender-specific code selection
  • ✓Quadrant or subsite location: nipple and areola
  • ✓Tumor size (T stage) and grade
  • ✓Lymph node status (N stage) — axillary, sentinel node biopsy results
  • ✓Estrogen receptor, progesterone receptor, and HER2 status
  • ✓Stage grouping (I-IV)
  • ✓Current treatment status (active treatment, hormonal therapy, surveillance)

Commonly Confused Codes

  • •C50.012: Left female breast nipple/areola; verify laterality
  • •C50.019: Unspecified female breast; use only when laterality cannot be determined
  • •C50.021: Same laterality but male breast; verify patient gender
  • •C50.111-C50.119: Central portion of female breast; central portion is distinct from nipple/areola
  • •D05.x: Carcinoma in situ of breast; must distinguish invasive from in situ disease

Child Codes

C50.011Malignant neoplasm of nipple and areola, right female breast
HCC 22
C50.012Malignant neoplasm of nipple and areola, left female breast
HCC 22
C50.019Malignant neoplasm of nipple and areola, unspecified female breast
HCC 22

Code Hierarchy

└C50Malignant neoplasm of breast└C50.0Malignant neoplasm of nipple and areola└C50.01Malignant neoplasm of nipple and areola, female└C50.011Malignant neoplasm of nipple and areola, right female breast
└C50.011Malignant neoplasm of nipple and areola, right female breast

Also searched as

  • C50 011
  • C50011

For C50.011, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

C50.011 maps to CMS-HCC V28 category 23, Prostate, Breast, and Other Cancers and Tumors. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for C50.011. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

More on C50.011

Code family

Every C50 code with its CMS-HCC V28 statusMalignant neoplasm of breast, 57 billable codes

Related condition guides

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