C81.4A
BillableLymphocyte-rich Hodgkin lymphoma, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C81.4A an HCC code?
Yes. C81.4A maps to Breast, Prostate, Colorectal and Other Cancers and Tumors 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 C81.4A
For C81.4A 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 C81.4A during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C81.4A is the ICD-10-CM diagnosis code for lymphocyte-rich hodgkin lymphoma, in remission. Lymphocyte-rich Hodgkin lymphoma that is currently in remission (no active disease). C81.4A sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering malignant neoplasms of lymphoid, hematopoietic and related tissue (c81-c96).
Under the CMS-HCC V28 risk adjustment model, C81.4A maps to Breast, Prostate, Colorectal and Other Cancers and Tumors (HCC 21) with a community, non-dual, aged base RAF weight of 0.545. Under the older CMS-HCC V24 model, C81.4A 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.
Use only when documentation explicitly states remission status. Because C81.4A 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 C81.4A sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when documentation explicitly states remission status
- •Do not use if patient has residual disease or is in partial remission; clarify with provider if needed
Clinical Significance
Lymphocyte-rich Hodgkin lymphoma in remission reflects the excellent treatment response rates characteristic of this favorable subtype. Most patients with lymphocyte-rich histology achieve complete remission, but ongoing surveillance is still required to detect late relapses. This code captures the continued healthcare resource utilization during the surveillance phase and preserves appropriate risk adjustment.
Documentation Requirements
- ✓Explicit provider documentation of remission (complete or partial)
- ✓Supporting imaging (PET/CT) demonstrating no active disease
- ✓History of pathologically confirmed lymphocyte-rich Hodgkin lymphoma
- ✓Surveillance plan with scheduled follow-up imaging and labs
- ✓Encounter documentation confirming continued remission status