What is ICD-10 code C68.1?

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. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C68.1 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C68.1 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. C68.1 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. C68.1 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 C68.1 map to under V28?

C68.1 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 C68.1 pay in RAF?

C68.1 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 C68.1?

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 C68.1, 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 C68.1: Malignant neoplasm

C68.1 maps to CMS-HCC V28 22 (RAF 0.363). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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Code lookupC68.1Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

C68.1

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

Malignant neoplasm of paraurethral glands

Cancer of the paraurethral glands, small glands located near the urethra that produce mucus.

Buddy Insight

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.

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

C68Malignant neoplasm of other and unspecified urinary organs

C68.1Malignant neoplasm of paraurethral glands

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C68.1 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C68.1 in this effective period.

Related Child Codes

Official

C68.0Malignant neoplasm of urethra

C68.8Malignant neoplasm of overlapping sites of urinary organs

C68.9Malignant neoplasm of urinary organ, unspecified

Includes

Official

ICD-10-CM does not list Includes notes for C68.1 in this effective period.

Excludes 1

Official

malignant neoplasm of female genitourinary tract NOS (C57.9)
malignant neoplasm of male genitourinary tract NOS (C63.9)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C68.1 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C68.1 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C68.1 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Defaulting to urethral cancer (C68.0) when pathology shows paraurethral gland origin

Misidentifying as vaginal cancer in female patients due to anatomical proximity

Using unspecified urinary organ code (C68.9) when pathology clearly identifies paraurethral gland involvement

Common Mistakes

HCC Buddy guidance

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

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 C68.1 an HCC code?

Yes. C68.1 (Malignant neoplasm of paraurethral glands) 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: C68.1 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: C68.1
Description: Malignant neoplasm of paraurethral glands
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 C68.1 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for C68.1

For C68.1 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 C68.1 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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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