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

C61 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 Buddy coding tools

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Code lookupC61

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.

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

HCC 012

Code-level coefficient reference

ESRD/PACE

HCC 12

Code-level coefficient reference

RXHCC

HCC 22

Code-level coefficient reference

Code Book Path

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

Inclusion Terms

Official

No inclusion terms are included in this display for C61. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for C61. Check the code and parent instructions in the Code Book.

Related Codes

Official

No related codes are included in this display for C61. Check the Code Book for the complete code path.

Includes

Official
  • malignant neoplasm of skin of male genital organsInherited from C60-C63

Excludes 1

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

Code First

Official

No Code First sequencing instructions are included in this display for C61. Check the code and parent instructions in the Code Book.

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

No Code Also instructions are included in this display for C61. Check the code and parent instructions in the Code Book.

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

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 C61 an HCC code?

Yes. C61 (Malignant neoplasm of prostate) 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: C61 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
C61
Description
Malignant neoplasm of prostate
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
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 C61 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C61

For C61, 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

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 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.

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. For C61, 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 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. 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

Also searched as

  • prostate cancer
  • CA prostate

For C61, 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.

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. The mapping identifies a payment HCC category for C61. 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.

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