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C61 ICD-10-CM Code: Malignant neoplasm of prostate

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FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of male genital organs (C60-C63)

C61

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

Malignant neoplasm of prostate

Cancer that starts in the prostate gland, which is part of the male reproductive system. This is one of the most common cancers in men.

Buddy the Bee presenting code insight

Buddy Insight

Prostate cancer is one of the most common cancers in men and a high-volume risk adjustment code.

CMS-HCC V28

HCC 23

RAF 0.186

CMS-HCC V24

HCC 12

RAF 0.150

ACA/HHS

HCC 12

Varies by metal level

ESRD/PACE

HCC 12

RAF 0.045

RXHCC

HCC 22

RAF 0.124

Code Book Path

Official
C6Malignant neoplasms of male genital organs (C60-C63)
C61Malignant neoplasm of prostate

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C61 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C61 in this effective period.

Related Child Codes

Official

ICD-10-CM does not list child codes under C61 for this display context.

Includes

Official

ICD-10-CM does not list Includes notes for C61 in this effective period.

Excludes 1

Official
  • malignant neoplasm of seminal vesicle (C63.7)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C61 in this effective period.

Use Additional

Official
  • code, if applicable, to identify:
  • hormone sensitivity status (Z19.1-Z19.2)
  • rising PSA following treatment for malignant neoplasm of prostate (R97.21)

Code Also

Official

ICD-10-CM does not list Code Also instructions for C61 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Pathology confirming adenocarcinoma or other histologic type of prostate cancer
Gleason score or Grade Group
TNM staging or clinical stage
PSA level and trend

MEAT Support

HCC Buddy guidance
Pathology confirming adenocarcinoma or other histologic type of prostate cancer
Gleason score or Grade Group
TNM staging or clinical stage
PSA level and trend

Audit Caution

HCC Buddy guidance
Coding C61 for a patient whose prostate cancer was treated and is now in remission — use Z85.46 for history
Failing to recognize that active surveillance for low-grade prostate cancer still supports C61
Coding elevated PSA (R97.20) as prostate cancer without pathologic confirmation
Not documenting whether the patient has active disease vs. history at each encounter

Common Mistakes

HCC Buddy guidance
Z85.46 — Personal history of prostate cancer; use when treatment is complete with no evidence of disease
D07.5 — Carcinoma in situ of prostate (prostatic intraepithelial neoplasia); not invasive cancer
N40.0-N40.1 — Benign prostatic hyperplasia; entirely different condition
D40.0 — Neoplasm of uncertain behavior of prostate; use when histology is inconclusive

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is C61 an HCC code?

Yes. C61 maps to Prostate, Breast, and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors under V24).

HCC Category Mapping

V28HCC 23, Prostate, Breast, and Other Cancers and Tumors
0.186
V24HCC 12, Breast, Prostate, and Other Cancers and Tumors
0.150
ESRDHCC 12, Breast, Prostate, and Other Cancers and Tumors
0.045
RxHCCHCC 22, Cancer, Other Specified Sites
0.124

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work C61 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for C61

For C61to 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 C61 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

C61 is the ICD-10-CM diagnosis code for malignant neoplasm of prostate. Cancer that starts in the prostate gland, which is part of the male reproductive system. This is one of the most common cancers in men. C61 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of male genital organs (c60-c63).

Under the CMS-HCC V28 risk adjustment model, C61 maps to Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a community, non-dual, aged base RAF weight of 0.186. Under the older CMS-HCC V24 model, C61 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.

C61 is the parent code for prostate cancer; always check for fifth or sixth character extensions that specify the histological type (e.g., C61.9 for unspecified) or laterality if applicable. Because C61 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 C61 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •C61 is the parent code for prostate cancer; always check for fifth or sixth character extensions that specify the histological type (e.g., C61.9 for unspecified) or laterality if applicable
  • •Verify documentation includes staging information (TNM stage) and histology type, as these may be coded separately with additional codes from the C80-C97 range for better specificity and treatment planning

Clinical Significance

Prostate cancer is one of the most common cancers in men and a high-volume risk adjustment code. It is critical to distinguish active prostate cancer from personal history of prostate cancer (Z85.46), as the coding and RAF implications are vastly different. Active disease must be supported by ongoing treatment, rising PSA, or documented recurrence. Watchful waiting and active surveillance still qualify as active disease.

Documentation Requirements

  • ✓Pathology confirming adenocarcinoma or other histologic type of prostate cancer
  • ✓Gleason score or Grade Group
  • ✓TNM staging or clinical stage
  • ✓PSA level and trend
  • ✓Current treatment status: active treatment, active surveillance, watchful waiting, or post-treatment monitoring
  • ✓Documentation distinguishing active cancer from personal history

Excludes 1, Do NOT code together

  • malignant neoplasm of seminal vesicle (C63.7)

Use Additional Code

  • code, if applicable, to identify:
  • hormone sensitivity status (Z19.1-Z19.2)
  • rising PSA following treatment for malignant neoplasm of prostate (R97.21)

Commonly Confused Codes

  • •Z85.46: Personal history of prostate cancer; use when treatment is complete with no evidence of disease
  • •D07.5: Carcinoma in situ of prostate (prostatic intraepithelial neoplasia); not invasive cancer
  • •N40.0-N40.1: Benign prostatic hyperplasia; entirely different condition
  • •D40.0: Neoplasm of uncertain behavior of prostate; use when histology is inconclusive

Code Hierarchy

└C61Malignant neoplasm of prostate
└C61Malignant neoplasm of prostate

Because C61 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

C61 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.

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