What is ICD-10 code C67.5?

C67.5 is the ICD-10-CM diagnosis code for Malignant neoplasm of bladder neck. Cancer that starts at the bladder neck, the narrow opening where urine exits the bladder into the urethra. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C67.5 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C67.5 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. C67.5 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. C67.5 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does C67.5 map to under V28?

C67.5 maps to CMS-HCC V28 22 (Bladder, Colorectal, and Other Cancers). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does C67.5 pay in RAF?

C67.5 carries a community, non-dual, aged (CNA) RAF weight of 0.363 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for C67.5?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For C67.5, V28 maps to Bladder, Colorectal, and Other Cancers at RAF 0.363 while V24 mapped to Colorectal, Bladder, and Other Cancers at RAF 0.307. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM C67.5: Malignant neoplasm of bladder

C67.5 maps to CMS-HCC V28 22 (RAF 0.363). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupC67.5Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of urinary tract (C64-C68)

C67.5

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

Malignant neoplasm of bladder neck

Cancer that starts at the bladder neck, the narrow opening where urine exits the bladder into the urethra.

Buddy Insight

Bladder neck malignancy carries unique clinical significance because this anatomical location directly affects urinary outflow and continence.

CMS-HCC V28

Mapped

HCC 22

Bladder, Colorectal, and Othe...

RAF 0.363

CMS-HCC V24

Mapped

HCC 11

Colorectal, Bladder, and Othe...

RAF 0.307

ACA/HHS

Mapped

HCC 12

HHS-HCC 12

Varies by metal level

ESRD/PACE

Mapped

HCC 11

Colorectal, Bladder, and Othe...

RAF 0.059

RXHCC

Mapped

HCC 22

Cancer, Other Specified Sites

RAF 0.124

Code Book Path

Official

C67Malignant neoplasm of bladder

C67.5Malignant neoplasm of bladder neck

Inclusion Terms

Official

Malignant neoplasm of internal urethral orifice

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C67.5 in this effective period.

Related Child Codes

Official

C67.0Malignant neoplasm of trigone of bladder

C67.1Malignant neoplasm of dome of bladder

C67.2Malignant neoplasm of lateral wall of bladder

C67.3Malignant neoplasm of anterior wall of bladder

C67.4Malignant neoplasm of posterior wall of bladder

Includes

Official

ICD-10-CM does not list Includes notes for C67.5 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C67.5 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C67.5 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C67.5 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C67.5 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Pathology report confirming malignancy with histological type

Documentation specifying bladder neck as the tumor location (not simply 'lower bladder')

Cystoscopy or imaging confirming anatomical site

Stage and grade of tumor

MEAT Support

HCC Buddy guidance

Pathology report confirming malignancy with histological type

Documentation specifying bladder neck as the tumor location (not simply 'lower bladder')

Cystoscopy or imaging confirming anatomical site

Stage and grade of tumor

Audit Caution

HCC Buddy guidance

Confusing bladder neck with ureteric orifice — these are at opposite ends of the bladder

Defaulting to C67.9 when documentation clearly states 'tumor at the bladder neck' or 'bladder outlet'

Coding as urethral cancer (C68.0) when the primary origin is the bladder neck with extension into the urethra

Common Mistakes

HCC Buddy guidance

C67.6 — Ureteric orifice: the bladder neck is where urine exits into the urethra, while the ureteric orifice is where the ureter enters the bladder; completely different anatomical locations

C68.0 — Malignant neoplasm of urethra: bladder neck is the junction; if tumor extends into the urethra, determine the primary site

C67.9 — Bladder, unspecified: query for bladder neck specificity when provider documents 'lower bladder tumor'

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 C67.5 an HCC code?

Yes. C67.5 (Malignant neoplasm of bladder neck) maps to Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model (and Colorectal, Bladder, and Other Cancers under V24), with a community non-dual aged RAF of 0.363. It is billable for payment year 2026.

Coder answer: C67.5 is billable and maps to V28 HCC 22, Bladder, Colorectal, and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: C67.5
Description: Malignant neoplasm of bladder neck
HCC (V28): HCC 22 — Bladder, Colorectal, and Other Cancers
RAF: 0.363
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 22, Bladder, Colorectal, and Other Cancers

0.363

V24HCC 11, Colorectal, Bladder, and Other Cancers

0.307

ESRDHCC 11, Colorectal, Bladder, and Other Cancers

0.059

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 C67.5 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for C67.5

For C67.5 to 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 C67.5 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

C67.5 is the ICD-10-CM diagnosis code for malignant neoplasm of bladder neck. Cancer that starts at the bladder neck, the narrow opening where urine exits the bladder into the urethra. C67.5 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of urinary tract (c64-c68).

Under the CMS-HCC V28 risk adjustment model, C67.5 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.363. Under the older CMS-HCC V24 model, C67.5 maps to Colorectal, Bladder, and Other Cancers (HCC 11) with a community, non-dual, aged base RAF weight of 0.307. 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.

Bladder neck involvement affects urinary function and treatment options. Because C67.5 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 C67.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Bladder neck involvement affects urinary function and treatment options
•Distinguish from ureteric orifice (C67.6) which is where ureters enter the bladder

Clinical Significance

Bladder neck malignancy carries unique clinical significance because this anatomical location directly affects urinary outflow and continence. Tumors here frequently cause obstructive urinary symptoms and may require complex surgical intervention including radical cystectomy with urinary diversion, driving higher resource utilization.

Documentation Requirements

✓Pathology report confirming malignancy with histological type
✓Documentation specifying bladder neck as the tumor location (not simply 'lower bladder')
✓Cystoscopy or imaging confirming anatomical site
✓Stage and grade of tumor
✓Current treatment status — active, remission, or surveillance

Commonly Confused Codes

•C67.6: Ureteric orifice: the bladder neck is where urine exits into the urethra, while the ureteric orifice is where the ureter enters the bladder; completely different anatomical locations
•C68.0: Malignant neoplasm of urethra: bladder neck is the junction; if tumor extends into the urethra, determine the primary site
•C67.9: Bladder, unspecified: query for bladder neck specificity when provider documents 'lower bladder tumor'