C54.3 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

ICD-10-CM Code View

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Code lookupC54.3

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of female genital organs (C51-C58)

C54.3

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

Malignant neoplasm of fundus uteri

Cancer located in the fundus, which is the upper rounded portion of the uterus. This code specifies the anatomical location of the uterine cancer.

Buddy Insight

Malignant neoplasm of the fundus uteri involves the dome-shaped upper portion of the uterus.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 23

Prostate, Breast, and Other C...

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

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 012

HHS-HCC 012 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 12

Breast/Prostate/and Other Can...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

C54Malignant neoplasm of corpus uteri C54.3Malignant neoplasm of fundus uteri

Inclusion Terms

Official

No inclusion terms are included in this display for C54.3. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for C54.3. Check the code and parent instructions in the Code Book.

Related Codes

Official

C54.0Malignant neoplasm of isthmus uteri C54.1Malignant neoplasm of endometrium C54.2Malignant neoplasm of myometrium C54.8Malignant neoplasm of overlapping sites of corpus uteri C54.9Malignant neoplasm of corpus uteri, unspecified

Includes

Official

malignant neoplasm of skin of female genital organsInherited from C51-C58

Excludes 1

Official

No Excludes 1 notes are included in this display for C54.3. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for C54.3. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for C54.3. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for C54.3. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Specific site confirmed as fundus uteri (upper dome of uterus)

Histological type and grade

FIGO staging

Depth of myometrial invasion

MEAT Support

HCC Buddy guidance

Specific site confirmed as fundus uteri (upper dome of uterus)

Histological type and grade

FIGO staging

Depth of myometrial invasion

Audit Caution

HCC Buddy guidance

Confusion between coding by tissue type (C54.1 endometrium) versus anatomical location (C54.3 fundus) — review documentation context carefully

Coding a tumor extending from the fundus to involve the tube/ovary as fundus primary when it may be a tubo-ovarian primary

Using unspecified corpus uteri code when fundus is specifically identified

Not recognizing that 'uterine fundus' and 'fundus uteri' are the same anatomical location

Common Mistakes

HCC Buddy guidance

C54.1 — Malignant neoplasm of endometrium; the fundus contains endometrium, but C54.3 is used when the anatomical subsite 'fundus' is specified rather than the tissue type 'endometrium'

C54.0 — Isthmus uteri; opposite end of the uterine body from the fundus

C54.9 — Corpus uteri, unspecified; less specific when fundus is documented

C54.8 — Overlapping sites of corpus uteri; use when tumor extends from fundus to involve other uterine structures

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 C54.3 an HCC code?

Yes. C54.3 (Malignant neoplasm of fundus uteri) 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: C54.3 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: C54.3
Description: Malignant neoplasm of fundus uteri
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

ESRDHCC 12, Breast/Prostate/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 C54.3 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C54.3

For C54.3, 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

C54.3 is the ICD-10-CM diagnosis code for malignant neoplasm of fundus uteri. Cancer located in the fundus, which is the upper rounded portion of the uterus. This code specifies the anatomical location of the uterine cancer. C54.3 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of female genital organs (c51-c58).

Under the CMS-HCC V28 risk adjustment model, C54.3 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 documentation specifically identifies fundus as the primary site. For C54.3, 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 C54.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code when documentation specifically identifies fundus as the primary site
•May be used in conjunction with histology codes to provide complete cancer classification

Clinical Significance

Malignant neoplasm of the fundus uteri involves the dome-shaped upper portion of the uterus. The fundus is the most common location for endometrial cancer, and specific documentation of this site supports accurate staging and treatment planning. Tumors at the fundus may extend toward the fallopian tube ostia, potentially affecting surgical approach.

Documentation Requirements

✓Specific site confirmed as fundus uteri (upper dome of uterus)
✓Histological type and grade
✓FIGO staging
✓Depth of myometrial invasion
✓Extension to adjacent structures (fallopian tubes, ovaries, serosa)
✓Lymph node status
✓Tumor size and peritoneal cytology results

Commonly Confused Codes

•C54.1: Malignant neoplasm of endometrium; the fundus contains endometrium, but C54.3 is used when the anatomical subsite 'fundus' is specified rather than the tissue type 'endometrium'
•C54.0: Isthmus uteri; opposite end of the uterine body from the fundus
•C54.9: Corpus uteri, unspecified; less specific when fundus is documented
•C54.8: Overlapping sites of corpus uteri; use when tumor extends from fundus to involve other uterine structures