C68.1
BillableMalignant neoplasm of paraurethral glands
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C68.1 an HCC code?
Yes. C68.1 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 C68.1
For C68.1to 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 C68.1 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C68.1 is the ICD-10-CM diagnosis code for malignant neoplasm of paraurethral glands. Cancer of the paraurethral glands, small glands located near the urethra that produce mucus. C68.1 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, C68.1 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, C68.1 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.
This is a rare cancer; ensure documentation clearly identifies paraurethral gland involvement. Because C68.1 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 C68.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a rare cancer; ensure documentation clearly identifies paraurethral gland involvement
- •Verify distinction from urethral cancer and other urinary organ malignancies
Clinical Significance
Paraurethral gland malignancy (Skene's glands in females, Littre's glands in males) is extremely rare and may be misidentified as urethral or vaginal cancer. Accurate identification is essential for risk adjustment as these tumors require specialized surgical and oncologic management, and their rarity means they are frequently miscoded.
Documentation Requirements
- ✓Pathology explicitly identifying paraurethral gland as the primary site of malignancy
- ✓Histological type documented (commonly adenocarcinoma or clear cell carcinoma)
- ✓Clinical documentation distinguishing paraurethral origin from adjacent structures
- ✓Imaging or surgical findings confirming the glandular origin
- ✓Staging and treatment plan
Commonly Confused Codes
- •C68.0 — Malignant neoplasm of urethra: paraurethral glands are adjacent to but distinct from the urethra; verify pathology confirms glandular origin
- •C52 — Malignant neoplasm of vagina: in females, paraurethral gland tumors may be mistaken for vaginal cancer due to anatomical proximity
- •C68.8 — Overlapping sites of urinary organs: use if tumor involves both paraurethral glands and adjacent urinary structures