C85.1A
BillableUnspecified B-cell lymphoma, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C85.1A an HCC code?
Yes. C85.1A 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 C85.1A
For C85.1A 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 C85.1A during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C85.1A is the ICD-10-CM diagnosis code for unspecified b-cell lymphoma, in remission. A type of B-cell cancer that is currently in remission, meaning the cancer is not actively growing or has responded well to treatment. C85.1A 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, C85.1A 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, C85.1A 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 this code only when documentation explicitly states the patient is in remission or has achieved complete or partial response. Because C85.1A 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 C85.1A 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 documentation explicitly states the patient is in remission or has achieved complete or partial response
- •Do not use this code if there is any evidence of active disease or recurrence
Clinical Significance
Unspecified B-cell lymphoma in remission indicates a patient with a B-cell neoplasm that has responded to treatment but whose specific subtype was never fully characterized. Even in remission, these patients require ongoing surveillance with periodic imaging and laboratory monitoring. The unspecified nature of the B-cell subtype should prompt a query to determine if more specific classification is possible.
Documentation Requirements
- ✓Explicit provider documentation of 'remission' or 'complete response' — not just 'off treatment'
- ✓Original pathology report showing B-cell lineage (CD20+, CD19+, or other B-cell markers)
- ✓Date remission was achieved and method of assessment (PET/CT, bone marrow biopsy)
- ✓Surveillance plan including follow-up imaging and laboratory schedule
Commonly Confused Codes
- •Z85.79 (Personal history of other malignant neoplasms of lymphoid tissue) — Use history code when cancer is fully eradicated; use C85.1A when patient is in remission but still being monitored
- •C85.10 (Unspecified B-cell lymphoma, unspecified site) — C85.1A is specifically for remission status; C85.10 is for active disease with unknown site
- •C83.30-C83.3A (Diffuse large B-cell lymphoma) — If the B-cell subtype is known as DLBCL, use the specific C83.3 code series