What is ICD-10 code C7A.095?

C7A.095 is the ICD-10-CM diagnosis code for Malignant carcinoid tumor of the midgut, unspecified. A rare cancer that starts in hormone-producing cells of the middle section of the small intestine (midgut). This type of cancer grows slowly and can spread to other parts of the body. C7A.095 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C7A.095 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. C7A.095 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. C7A.095 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 C7A.095 map to under V28?

C7A.095 maps to CMS-HCC V28 HCC 21 (Lymphoma and Other Cancers). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM C7A.095: Malignant carcinoid tumor

C7A.095 maps to CMS-HCC V28 21. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupC7A.095

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neuroendocrine tumors (C7A)

C7A.095

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

Malignant carcinoid tumor of the midgut, unspecified

A rare cancer that starts in hormone-producing cells of the middle section of the small intestine (midgut). This type of cancer grows slowly and can spread to other parts of the body.

Buddy Insight

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 21

Lymphoma and Other Cancers

Code-level coefficient reference

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

C7A.0Malignant carcinoid tumors C7A.09Malignant carcinoid tumors of other sites C7A.095Malignant carcinoid tumor of the midgut, unspecified

Inclusion Terms

Official

No inclusion terms are included in this display for C7A.095. Check the code and parent instructions in the Code Book.

Excludes 2

Official

malignant pancreatic islet cell tumors (C25.4)Inherited from C7A
Merkel cell carcinoma (C4A.-)Inherited from C7A

Related Codes

Official

C7A.090Malignant carcinoid tumor of the bronchus and lung C7A.091Malignant carcinoid tumor of the thymus C7A.092Malignant carcinoid tumor of the stomach C7A.093Malignant carcinoid tumor of the kidney C7A.094Malignant carcinoid tumor of the foregut, unspecified

Includes

Official

No Includes notes are included in this display for C7A.095. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for C7A.095. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for C7A.095. Check the code and parent instructions in the Code Book.

Use Additional

Official

code to identify any associated endocrine syndrome, such as:Inherited from C7A
carcinoid syndrome (E34.00)Inherited from C7A

Code Also

Official

any associated multiple endocrine neoplasia [MEN] syndromes (E31.2-)Inherited from C7A

Buddy Documentation Tip

HCC Buddy guidance

Pathology confirming neuroendocrine/carcinoid histology

Documentation that the specific midgut site cannot be determined

24-hour urine 5-HIAA levels or serum serotonin levels

Imaging for mesenteric lymph node and liver metastases

MEAT Support

HCC Buddy guidance

Pathology confirming neuroendocrine/carcinoid histology

Documentation that the specific midgut site cannot be determined

24-hour urine 5-HIAA levels or serum serotonin levels

Imaging for mesenteric lymph node and liver metastases

Audit Caution

HCC Buddy guidance

Using this code when a more specific midgut site (ileum, appendix, jejunum) has been documented

Confusing midgut and hindgut boundaries — the midgut ends at the hepatic flexure of the colon

Failing to code carcinoid heart disease (I36.1, I36.8) as an additional manifestation when present

Not coding liver metastases separately with C7B.02 when documented

Common Mistakes

HCC Buddy guidance

C7A.010-C7A.012 — Site-specific small intestine carcinoid codes: Use these when duodenum, jejunum, or ileum is specifically identified

C7A.020 — Malignant carcinoid tumor of the appendix: Use when the appendix is specifically documented

C7A.094 — Malignant carcinoid tumor of the foregut, unspecified: Foregut includes proximal structures above the ligament of Treitz

C7A.096 — Malignant carcinoid tumor of the hindgut, unspecified: Hindgut includes distal colon and rectum

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 C7A.095 an HCC code?

Yes. C7A.095 (Malignant carcinoid tumor of the midgut, unspecified) maps to HCC 21, Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.671. 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: C7A.095 is billable and maps to V28 HCC 21, Lymphoma and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: C7A.095
Description: Malignant carcinoid tumor of the midgut, unspecified
HCC (V28): HCC 21 — Lymphoma and Other Cancers
RAF reference coefficient: 0.671
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 21, Lymphoma and Other Cancers

0.671

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 C7A.095 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C7A.095

For C7A.095, 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

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What This Code Means

C7A.095 is the ICD-10-CM diagnosis code for malignant carcinoid tumor of the midgut, unspecified. A rare cancer that starts in hormone-producing cells of the middle section of the small intestine (midgut). This type of cancer grows slowly and can spread to other parts of the body. C7A.095 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neuroendocrine tumors (c7a).

Under the CMS-HCC V28 risk adjustment model, C7A.095 maps to Lymphoma and Other Cancers (HCC 21) with a source-labeled community, non-dual, aged reference coefficient of 0.671. No V24 mapping is shown for C7A.095; use the applicable model and payment year when reviewing the V28 mapping. 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.

Verify the exact location of the carcinoid tumor in the midgut (duodenum, jejunum, or ileum) as more specific codes may be available if documentation specifies the site. For C7A.095, 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 C7A.095 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify the exact location of the carcinoid tumor in the midgut (duodenum, jejunum, or ileum) as more specific codes may be available if documentation specifies the site
•Ensure the neoplasm is documented as malignant and originating in the midgut; carcinoid tumors in other GI locations have different codes

Clinical Significance

Malignant carcinoid tumor of the midgut represents a neuroendocrine malignancy originating in midgut-derived structures (distal duodenum, jejunum, ileum, appendix, ascending colon) when the specific site cannot be determined. Midgut carcinoids are the most common type of gastrointestinal carcinoid and are most likely to produce classic carcinoid syndrome with serotonin-mediated flushing, diarrhea, and right-sided cardiac valvular disease. They frequently metastasize to mesenteric lymph nodes and liver.

Documentation Requirements

✓Pathology confirming neuroendocrine/carcinoid histology
✓Documentation that the specific midgut site cannot be determined
✓24-hour urine 5-HIAA levels or serum serotonin levels
✓Imaging for mesenteric lymph node and liver metastases
✓Echocardiogram results if carcinoid syndrome is present (carcinoid heart disease screening)
✓Current treatment (somatostatin analogs, targeted therapy, surgery)

Commonly Confused Codes

•C7A.010-C7A.012: Site-specific small intestine carcinoid codes: Use these when duodenum, jejunum, or ileum is specifically identified
•C7A.020: Malignant carcinoid tumor of the appendix: Use when the appendix is specifically documented
•C7A.094: Malignant carcinoid tumor of the foregut, unspecified: Foregut includes proximal structures above the ligament of Treitz
•C7A.096: Malignant carcinoid tumor of the hindgut, unspecified: Hindgut includes distal colon and rectum