C81.94
BillableHodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C81.94 an HCC code?
Yes. C81.94 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 C81.94
For C81.94 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 C81.94 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C81.94 is the ICD-10-CM diagnosis code for hodgkin lymphoma, unspecified, lymph nodes of axilla and upper limb. This code describes Hodgkin lymphoma (a type of cancer affecting lymph cells) that has spread to or is located in the lymph nodes of the armpit and upper arm area, but the specific subtype of Hodgkin lymphoma has not been specified. Hodgkin lymphoma is a serious blood cancer that requires immediate medical attention and treatment. C81.94 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, C81.94 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, C81.94 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.
Verify the documentation specifies the anatomical location as axilla and/or upper limb lymph nodes; if lymph nodes in other locations are also involved, additional codes may be needed to capture all affected sites. Because C81.94 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 C81.94 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the documentation specifies the anatomical location as axilla and/or upper limb lymph nodes; if lymph nodes in other locations are also involved, additional codes may be needed to capture all affected sites
- •Confirm whether the histological subtype (nodular sclerosis, mixed cellularity, lymphocyte-rich, or lymphocyte-depleted) is documented; if available, use the more specific subtype code instead of 'unspecified'
Clinical Significance
Hodgkin lymphoma of unspecified type affecting axillary and upper limb lymph nodes represents a confirmed diagnosis at an accessible peripheral site without histologic subtype determination. Axillary lymphadenopathy may be the initial finding on physical exam or mammographic screening. The subtype should be determined through pathology to optimize treatment selection.
Documentation Requirements
- ✓Confirmed Hodgkin lymphoma diagnosis involving axillary or upper limb nodes
- ✓Physical exam or imaging documentation of the involved site
- ✓Laterality documentation when available
- ✓Explanation for unspecified subtype status
- ✓Provider assessment and treatment plan
Commonly Confused Codes
- •C81.74 — Other Hodgkin lymphoma, axilla/upper limb: pathology reviewed but classified as non-standard variant
- •C77.3 — Secondary malignant neoplasm, axillary nodes: for metastatic carcinoma, not primary lymphoma
- •C81.14 — Nodular sclerosis Hodgkin lymphoma, axilla/upper limb: use when pathology confirms specific subtype