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C50.411 ICD-10-CM Code: Malignant neoplasm of upper-outer quadrant of right female breast

C50.411 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 coding software

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Code lookupC50.411

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

C50.411

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

Malignant neoplasm of upper-outer quadrant of right female breast

Cancer that starts in the upper-outer area of the right breast in a female patient.

Buddy the Bee presenting code insight

Buddy Insight

Malignant neoplasm of the upper-outer quadrant of 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
C50.4Malignant neoplasm of upper-outer quadrant of breastC50.41Malignant neoplasm of upper-outer quadrant of breast, femaleC50.411Malignant neoplasm of upper-outer quadrant of right female breast

Inclusion Terms

Official

No inclusion terms are included in this display for C50.411. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for C50.411. Check the code and parent instructions in the Code Book.

Related Codes

Official
C50.412Malignant neoplasm of upper-outer quadrant of left female breastC50.419Malignant neoplasm of upper-outer quadrant of 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 C50.411. 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 C50.411. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Pathologic confirmation of invasive malignancy (biopsy with histologic type — ductal, lobular, etc.)
Laterality: right breast
Gender documented as female to support gender-specific code selection
Quadrant or subsite location: upper-outer quadrant

MEAT Support

HCC Buddy guidance
Pathologic confirmation of invasive malignancy (biopsy with histologic type — ductal, lobular, etc.)
Laterality: right breast
Gender documented as female to support gender-specific code selection
Quadrant or subsite location: upper-outer quadrant

Audit Caution

HCC Buddy guidance
The upper-outer quadrant is the most common site for breast cancer — do not assume all breast cancers are upper-outer without verifying documentation
Confusing upper-outer (toward axilla) with upper-inner (toward sternum) — this is the most frequent quadrant error
Using wrong gender code — C50.41x is female, C50.42x is male
Selecting wrong laterality — verify right side from imaging and pathology

Common Mistakes

HCC Buddy guidance
C50.412 — Upper-outer quadrant of left female breast; verify laterality
C50.419 — Upper-outer quadrant unspecified female; use only when laterality unknown
C50.421 — Same laterality but male breast; verify patient gender
C50.211-C50.219 — Upper-inner quadrant; most common confusion — upper-outer is lateral (toward axilla), upper-inner is medial (toward sternum)

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 C50.411 an HCC code?

Yes. C50.411 (Malignant neoplasm of upper-outer quadrant of 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: C50.411 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
C50.411
Description
Malignant neoplasm of upper-outer quadrant of 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 C50.411 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C50.411

For C50.411, 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

C50.411 is the ICD-10-CM diagnosis code for malignant neoplasm of upper-outer quadrant of right female breast. Cancer that starts in the upper-outer area of the right breast in a female patient. C50.411 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, C50.411 maps to Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a source-labeled community, non-dual, aged reference coefficient of 0.186. 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 upper-outer quadrant of right female breast, the most common breast cancer sub-site. Typically captured in surgical pathology clock-position detail. For C50.411, 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 C50.411 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Malignant neoplasm of upper-outer quadrant of right female breast, the most common breast cancer sub-site. Typically captured in surgical pathology clock-position detail.
  • •Sub-site specificity matters for tumor registry reporting and treatment planning. Pathology reports typically support specificity.

Clinical Significance

Malignant neoplasm of the upper-outer quadrant of 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 invasive malignancy (biopsy with histologic type — ductal, lobular, etc.)
  • ✓Laterality: right breast
  • ✓Gender documented as female to support gender-specific code selection
  • ✓Quadrant or subsite location: upper-outer quadrant
  • ✓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

  • •C50.412: Upper-outer quadrant of left female breast; verify laterality
  • •C50.419: Upper-outer quadrant unspecified female; use only when laterality unknown
  • •C50.421: Same laterality but male breast; verify patient gender
  • •C50.211-C50.219: Upper-inner quadrant; most common confusion: upper-outer is lateral (toward axilla), upper-inner is medial (toward sternum)
  • •C50.511-C50.519: Lower-outer quadrant; same lateral orientation but lower position
  • •C50.811-C50.819: Overlapping sites; use when tumor spans multiple quadrants

Child Codes

C50.411Malignant neoplasm of upper-outer quadrant of right female breast
HCC 22
C50.412Malignant neoplasm of upper-outer quadrant of left female breast
HCC 22
C50.419Malignant neoplasm of upper-outer quadrant of unspecified female breast
HCC 22

Code Hierarchy

└C50Malignant neoplasm of breast└C50.4Malignant neoplasm of upper-outer quadrant of breast└C50.41Malignant neoplasm of upper-outer quadrant of breast, female└C50.411Malignant neoplasm of upper-outer quadrant of right female breast
└C50.411Malignant neoplasm of upper-outer quadrant of right female breast

Also searched as

  • C50 411
  • C50411

For C50.411, 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.

C50.411 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 C50.411. 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 C50.411

Code family

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

Related condition guides

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