C76.40 maps to CMS-HCC V28 23. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupC76.40

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of ill-defined, other secondary and unspecified sites (C76-C80)

C76.40

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

Malignant neoplasm of unspecified upper limb

Cancer that has developed in an upper arm or hand, but the specific side (left or right) is not documented.

Buddy Insight

Malignant neoplasm of an unspecified upper limb represents cancer in the upper extremity (arm, forearm, hand) where the specific tissue, site, or laterality cannot be determined.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 23

Prostate, Breast, and Other C...

Coefficient HCC 23: 0.186 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 012

HHS-HCC 012 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 12

Breast/Prostate/and Other Can...

Code-level coefficient reference

RXHCC

Mapped

HCC 22

Prostate, Breast, Bladder, an...

Code-level coefficient reference

Code Book Path

Official

C76Malignant neoplasm of other and ill-defined sites C76.4Malignant neoplasm of upper limb C76.40Malignant neoplasm of unspecified upper limb

Inclusion Terms

Official

No inclusion terms are included in this display for C76.40. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for C76.40. Check the code and parent instructions in the Code Book.

Related Codes

Official

C76.41Malignant neoplasm of right upper limb C76.42Malignant neoplasm of left upper limb

Includes

Official

No Includes notes are included in this display for C76.40. Check the code and parent instructions in the Code Book.

Excludes 1

Official

malignant neoplasm of female genitourinary tract NOS (C57.9)Inherited from C76
malignant neoplasm of male genitourinary tract NOS (C63.9)Inherited from C76
malignant neoplasm of lymphoid, hematopoietic and related tissue (C81-C96)Inherited from C76
malignant neoplasm of skin (C44.-)Inherited from C76
malignant neoplasm of unspecified site NOS (C80.1)Inherited from C76

Code First

Official

No Code First sequencing instructions are included in this display for C76.40. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for C76.40. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for C76.40. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation confirming upper limb malignancy

Laterality — query provider for right (C76.41) or left (C76.42) specification

Pathology identifying tissue type (bone, soft tissue, skin, nerve)

Imaging documenting tumor location and extent within the upper extremity

MEAT Support

HCC Buddy guidance

Documentation confirming upper limb malignancy

Laterality — query provider for right (C76.41) or left (C76.42) specification

Pathology identifying tissue type (bone, soft tissue, skin, nerve)

Imaging documenting tumor location and extent within the upper extremity

Audit Caution

HCC Buddy guidance

Using this ill-defined code when the tissue of origin (bone, skin, soft tissue) is documented

Not querying for laterality when clinical records clearly identify right or left

Confusing primary upper limb malignancy with metastatic disease to the upper extremity

Not reviewing pathology that would direct coding to a more specific tissue-based code

Common Mistakes

HCC Buddy guidance

C76.41/C76.42 — Right/left upper limb: Use lateralized codes when side is documented

C40.00-C40.02 — Malignant neoplasm of scapula/long bones of upper limb: Bone tumors have specific codes

C49.10-C49.12 — Malignant neoplasm of connective tissue of upper limb: Soft tissue sarcomas have specific codes

C43.60-C43.62 — Melanoma of upper limb: Skin melanoma has specific codes

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 C76.40 an HCC code?

Yes. C76.40 (Malignant neoplasm of unspecified upper limb) maps to HCC 23, Prostate, Breast, and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.186. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: C76.40 is billable and maps to V28 HCC 23, Prostate, Breast, and Other Cancers and Tumors. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: C76.40
Description: Malignant neoplasm of unspecified upper limb
HCC (V28): HCC 23 — Prostate, Breast, and Other Cancers and Tumors
RAF reference coefficient: 0.186
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 23, Prostate, Breast, and Other Cancers and Tumors

0.186

ESRDHCC 12, Breast/Prostate/and Other Cancers and Tumors

Not separately weighted

RxHCCHCC 22, Prostate, Breast, Bladder, and Other Cancers and Tumors

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work C76.40 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C76.40

For C76.40, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

C76.40 is the ICD-10-CM diagnosis code for malignant neoplasm of unspecified upper limb. Cancer that has developed in an upper arm or hand, but the specific side (left or right) is not documented. C76.40 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of ill-defined, other secondary and unspecified sites (c76-c80).

Under the CMS-HCC V28 risk adjustment model, C76.40 maps to Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a source-labeled community, non-dual, aged reference coefficient of 0.186. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Use this code only when laterality (left/right) cannot be determined from documentation; otherwise use C76.41 or C76.42. For C76.40, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for C76.40 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only when laterality (left/right) cannot be determined from documentation; otherwise use C76.41 or C76.42
•This code represents malignant neoplasm of the upper limb including shoulder, arm, forearm, wrist, and hand

Clinical Significance

Malignant neoplasm of an unspecified upper limb represents cancer in the upper extremity (arm, forearm, hand) where the specific tissue, site, or laterality cannot be determined. This is an ill-defined site code used when the malignancy overlaps or involves structures that cannot be attributed to a specific tissue of origin.

Documentation Requirements

✓Documentation confirming upper limb malignancy
✓Laterality — query provider for right (C76.41) or left (C76.42) specification
✓Pathology identifying tissue type (bone, soft tissue, skin, nerve)
✓Imaging documenting tumor location and extent within the upper extremity
✓Attempts to determine specific tissue of origin for more precise coding

Commonly Confused Codes

•C76.41/C76.42: Right/left upper limb: Use lateralized codes when side is documented
•C40.00-C40.02: Malignant neoplasm of scapula/long bones of upper limb: Bone tumors have specific codes
•C49.10-C49.12: Malignant neoplasm of connective tissue of upper limb: Soft tissue sarcomas have specific codes
•C43.60-C43.62: Melanoma of upper limb: Skin melanoma has specific codes
•C44.60-C44.69: Other skin cancer of upper limb: Non-melanoma skin cancer has specific codes