C50.119
BillableMalignant neoplasm of central portion of unspecified female breast
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C50.119 an HCC code?
Yes. C50.119 maps to Melanoma and Other Skin Cancers 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 C50.119
For C50.119 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 C50.119 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C50.119 is the ICD-10-CM diagnosis code for malignant neoplasm of central portion of unspecified female breast. Cancer in the central portion of a female breast where the specific side (left or right) is not identified. C50.119 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, C50.119 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, C50.119 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.
This unspecified code should only be used when laterality cannot be determined from documentation. Because C50.119 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 C50.119 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This unspecified code should only be used when laterality cannot be determined from documentation
- •Query the provider if possible to determine whether the cancer is in the right or left breast for more specific coding
Clinical Significance
Malignant neoplasm of the central portion of unspecified 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. The unspecified laterality indicates documentation does not identify the affected side, which should trigger a provider query.
Documentation Requirements
- ✓Pathologic confirmation of invasive malignancy (biopsy with histologic type — ductal, lobular, etc.)
- ✓Laterality must be queried if not documented — right or left breast
- ✓Gender documented as female to support gender-specific code selection
- ✓Quadrant or subsite location: central portion
- ✓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
- •C50.111 — Right female breast central portion; preferred when right documented
- •C50.112 — Left female breast central portion; preferred when left documented
- •C50.129 — Same laterality but male breast; verify patient gender
- •C50.011-C50.019 — Nipple and areola of female breast; central portion is the subareolar region behind the nipple, distinct from the nipple-areolar complex itself
- •C50.211-C50.219 — Upper-inner quadrant of female breast; adjacent but distinct location
- •D05.1x — Carcinoma in situ of breast, central portion; in situ vs. invasive distinction