C85.91
BillableNon-Hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C85.91 an HCC code?
Yes. C85.91 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 C85.91
For C85.91 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 C85.91 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C85.91 is the ICD-10-CM diagnosis code for non-hodgkin lymphoma, unspecified, lymph nodes of head, face, and neck. Non-Hodgkin lymphoma of unspecified type affecting the lymph nodes in the head, face, and neck region. C85.91 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, C85.91 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, C85.91 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 that the lymphoma is specifically in head, face, or neck lymph nodes rather than other sites. Because C85.91 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 C85.91 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that the lymphoma is specifically in head, face, or neck lymph nodes rather than other sites
- •This code is appropriate when the specific NHL subtype is unknown but the location is documented
Clinical Significance
Non-Hodgkin lymphoma, unspecified, involving lymph nodes of the head, face, and neck provides anatomical specificity but lacks subtype classification. Head and neck nodal lymphoma is a common presentation for both indolent and aggressive NHL subtypes and requires pathology for proper classification. While more specific than C85.90, this code should still prompt a query for the lymphoma subtype.
Documentation Requirements
- ✓Confirmation that the lymphoma is non-Hodgkin type (not Hodgkin or other hematologic malignancy)
- ✓Clinical or imaging documentation confirming head, face, or neck lymph node involvement (cervical, submandibular, preauricular, occipital nodes)
- ✓Query for pathology results identifying the specific lymphoma subtype
- ✓If subtype cannot be determined, document the reason and note it is non-Hodgkin in nature