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C50.811 ICD-10-CM Code: Malignant neoplasm of overlapping sites of right female breast

C50.811 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 · free HCC coding tools

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Code lookupC50.811

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

C50.811

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

Malignant neoplasm of overlapping sites of right female breast

Cancer that involves multiple overlapping areas of the right female breast rather than being confined to a single quadrant or region.

Buddy the Bee presenting code insight

Buddy Insight

Overlapping sites of the right female breast indicates a malignancy that spans multiple anatomical regions of the breast, which typically suggests a larger or more advanced tumor.

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
C50.8Malignant neoplasm of overlapping sites of breastC50.81Malignant neoplasm of overlapping sites of breast, femaleC50.811Malignant neoplasm of overlapping sites of right female breast

Inclusion Terms

Official

No inclusion terms are included in this display for C50.811. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for C50.811. Check the code and parent instructions in the Code Book.

Related Codes

Official
C50.812Malignant neoplasm of overlapping sites of left female breastC50.819Malignant neoplasm of overlapping sites 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 C50.811. 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 C50.811. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Confirmed female patient sex
Laterality documented as right breast
Documentation that the tumor involves two or more distinct anatomical subsites
Specific subsites involved identified in pathology or imaging

MEAT Support

HCC Buddy guidance
Confirmed female patient sex
Laterality documented as right breast
Documentation that the tumor involves two or more distinct anatomical subsites
Specific subsites involved identified in pathology or imaging

Audit Caution

HCC Buddy guidance
Confusing overlapping sites (tumor spans multiple areas) with unspecified site (location unknown)
Using overlapping site code for multifocal disease when each focus can be coded to a separate specific site
Not distinguishing between a single large tumor crossing quadrant boundaries versus multiple separate tumor foci
Selecting a single quadrant code when documentation clearly describes involvement of multiple regions

Common Mistakes

HCC Buddy guidance
C50.911 — Unspecified site of right female breast; used when the exact site is unknown, not when multiple known sites are involved
C50.411 — Upper-outer quadrant of right female breast; use when the primary site is confined to one quadrant
C50.812 — Overlapping sites of left female breast; laterality error
C80.1 — Malignant neoplasm without specification of site; this is far too nonspecific when the breast is identified

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 C50.811 an HCC code?

Yes. C50.811 (Malignant neoplasm of overlapping sites 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: C50.811 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
C50.811
Description
Malignant neoplasm of overlapping sites 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 C50.811 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C50.811

For C50.811, 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

C50.811 is the ICD-10-CM diagnosis code for malignant neoplasm of overlapping sites of right female breast. Cancer that involves multiple overlapping areas of the right female breast rather than being confined to a single quadrant or region. C50.811 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, C50.811 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.

Use this code when the tumor spans two or more distinct anatomical regions of the breast. For C50.811, 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 C50.811 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Use this code when the tumor spans two or more distinct anatomical regions of the breast
  • •Overlapping site designation may indicate more advanced local disease; ensure documentation supports this classification

Clinical Significance

Overlapping sites of the right female breast indicates a malignancy that spans multiple anatomical regions of the breast, which typically suggests a larger or more advanced tumor. This code is specifically designated for tumors that cannot be classified to a single breast subsite, carrying implications for staging, treatment planning, and prognosis.

Documentation Requirements

  • ✓Confirmed female patient sex
  • ✓Laterality documented as right breast
  • ✓Documentation that the tumor involves two or more distinct anatomical subsites
  • ✓Specific subsites involved identified in pathology or imaging
  • ✓Tumor size and extent of local invasion
  • ✓TNM staging and lymph node status
  • ✓Histological type and receptor status

Commonly Confused Codes

  • •C50.911: Unspecified site of right female breast; used when the exact site is unknown, not when multiple known sites are involved
  • •C50.411: Upper-outer quadrant of right female breast; use when the primary site is confined to one quadrant
  • •C50.812: Overlapping sites of left female breast; laterality error
  • •C80.1: Malignant neoplasm without specification of site; this is far too nonspecific when the breast is identified

Child Codes

C50.811Malignant neoplasm of overlapping sites of right female breast
HCC 22
C50.812Malignant neoplasm of overlapping sites of left female breast
HCC 22
C50.819Malignant neoplasm of overlapping sites of unspecified female breast
HCC 22

Code Hierarchy

└C50Malignant neoplasm of breast└C50.8Malignant neoplasm of overlapping sites of breast└C50.81Malignant neoplasm of overlapping sites of breast, female└C50.811Malignant neoplasm of overlapping sites of right female breast
└C50.811Malignant neoplasm of overlapping sites of right female breast

Also searched as

  • C50 811
  • C50811

For C50.811, 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.

C50.811 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 C50.811. 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 C50.811

Code family

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

Related condition guides

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