C76.41
BillableMalignant neoplasm of right upper limb
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C76.41 an HCC code?
Yes. C76.41 maps to Melanoma and Other Skin Cancers under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors 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 C76.41
For C76.41 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 C76.41 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C76.41 is the ICD-10-CM diagnosis code for malignant neoplasm of right upper limb. Cancer that has developed in the right upper arm, hand, or shoulder area. C76.41 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, C76.41 maps to Melanoma and Other Skin Cancers (HCC 23) with a community, non-dual, aged base RAF weight of 0.251. Under the older CMS-HCC V24 model, C76.41 maps to Breast, Prostate, and Other Cancers and Tumors (HCC 12) with a community, non-dual, aged base RAF weight of 0.150. 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.
Ensure documentation clearly specifies 'right' side before assigning this code. Because C76.41 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 C76.41 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation clearly specifies 'right' side before assigning this code
- •This includes malignancies of the right shoulder, upper arm, forearm, wrist, and hand
Clinical Significance
Malignant neoplasm of the right upper limb specifies cancer in the right arm, forearm, or hand where the specific tissue of origin is ill-defined. Laterality is documented but the overlapping or indeterminate nature of the tumor prevents assignment to a tissue-specific code. Proper documentation of the tissue of origin should be pursued.
Documentation Requirements
- ✓Documentation confirming right upper limb malignancy
- ✓Pathology with tissue typing to attempt more specific code assignment
- ✓Imaging documenting location and extent within the right upper extremity
- ✓Assessment of neurovascular involvement and functional status
- ✓Treatment plan including surgical approach and any adjuvant therapy
Commonly Confused Codes
- •C76.42 — Left upper limb: Laterality error; confirm right side
- •C76.40 — Unspecified upper limb: Use C76.41 when right side is documented
- •C40.01 — Malignant neoplasm of bones of right upper limb: Use when bone origin is confirmed
- •C49.11 — Connective tissue of right upper limb: Use for soft tissue sarcomas
- •C43.61 — Melanoma of right upper limb: Use for melanoma of the arm