C75.3
BillableMalignant neoplasm of pineal gland
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C75.3 an HCC code?
Yes. C75.3 maps to Lung and Other Severe Cancers under the CMS-HCC V28 risk adjustment model (and Lymphoma 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 C75.3
For C75.3 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 C75.3 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C75.3 is the ICD-10-CM diagnosis code for malignant neoplasm of pineal gland. A malignant (cancerous) tumor of the pineal gland, a small endocrine gland located deep in the brain that produces melatonin. C75.3 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of thyroid and other endocrine glands (c73-c75).
Under the CMS-HCC V28 risk adjustment model, C75.3 maps to Lung and Other Severe Cancers (HCC 20) with a community, non-dual, aged base RAF weight of 0.000. Under the older CMS-HCC V24 model, C75.3 maps to Lymphoma and Other Cancers (HCC 10) with a community, non-dual, aged base RAF weight of 0.675. 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.
Pineal gland tumors are rare; ensure documentation specifies malignancy rather than benign pineal cysts. Because C75.3 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 C75.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Pineal gland tumors are rare; ensure documentation specifies malignancy rather than benign pineal cysts
- •Coordinate with neurology/oncology documentation for tumor histology and staging
Clinical Significance
Malignant neoplasm of the pineal gland encompasses malignant tumors arising from the pineal gland, including pineoblastoma (the most common malignant type) and pineal parenchymal tumors of intermediate differentiation. Pineal tumors can cause obstructive hydrocephalus and Parinaud syndrome (upward gaze palsy). Pineoblastoma is a WHO Grade IV tumor with aggressive behavior, particularly in children.
Documentation Requirements
- ✓Pathology confirming malignancy with specific histological type (pineoblastoma, malignant pineal parenchymal tumor)
- ✓Imaging (MRI) documenting tumor size, extent, and any hydrocephalus
- ✓Cerebrospinal fluid cytology for tumor markers (alpha-fetoprotein, beta-hCG) to exclude germ cell tumors
- ✓Documentation of any mass effect symptoms (hydrocephalus, Parinaud syndrome)
- ✓Staging including evaluation for craniospinal dissemination
Commonly Confused Codes
- •D35.4 — Benign neoplasm of pineal gland: Pineocytomas are benign WHO Grade I tumors
- •D44.5 — Neoplasm of uncertain behavior of pineal gland: Use when malignancy grade is uncertain
- •C71.0-C71.9 — Malignant neoplasm of brain: Pineal tumors arise from the pineal gland, not brain parenchyma
- •C62.90 — Malignant neoplasm of testis: Pineal germ cell tumors may mimic gonadal tumors but are coded to brain/CNS