C68.0
BillableMalignant neoplasm of urethra
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C68.0 an HCC code?
Yes. C68.0 maps to Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model (and Colorectal, Bladder, and Other Cancers under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for C68.0
For C68.0to 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 C68.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C68.0 is the ICD-10-CM diagnosis code for malignant neoplasm of urethra. Cancer of the urethra, the tube that carries urine from the bladder out of the body. C68.0 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, C68.0 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, C68.0 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.
Distinguish between urethral cancer and bladder cancer, as they have different treatment approaches. Because C68.0 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 C68.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish between urethral cancer and bladder cancer, as they have different treatment approaches
- •Document the histological type and stage from the pathology report for complete coding
Clinical Significance
Primary urethral cancer is rare, accounting for less than 1% of all urogenital malignancies, making accurate coding critically important for tracking incidence and ensuring appropriate resource allocation. It has a distinct clinical course from bladder cancer with different treatment protocols, and its rarity means many coders may be unfamiliar with the coding distinctions.
Documentation Requirements
- ✓Pathology confirming primary malignancy of the urethra with histological type (squamous cell, transitional cell, or adenocarcinoma)
- ✓Documentation explicitly identifying the urethra as the primary tumor site (not extension from bladder)
- ✓Clinical staging and tumor location within the urethra (proximal, distal, or bulbar)
- ✓Gender-specific documentation, as urethral cancer biology differs between males and females
- ✓Imaging to evaluate for local extension and lymph node involvement
Excludes 1 — Do NOT code together
- malignant neoplasm of urethral orifice of bladder (C67.5)
Commonly Confused Codes
- •C67.5 — Bladder neck: the bladder neck is above the urethra; tumors extending from bladder neck into urethra should be coded by primary origin
- •C67.9 — Bladder, unspecified: verify primary site is truly urethra and not distal bladder
- •D09.19 — Carcinoma in situ of other urinary organs: do not use C68.0 for in situ disease
- •C79.19 — Secondary malignant neoplasm of other urinary organs: use for metastatic cancer to the urethra