C86.30
BillableSubcutaneous panniculitis-like T-cell lymphoma not having achieved remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C86.30 an HCC code?
Yes. C86.30 maps to Lymphoma and Other Cancers 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 C86.30
For C86.30 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 C86.30 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C86.30 is the ICD-10-CM diagnosis code for subcutaneous panniculitis-like t-cell lymphoma not having achieved remission. A rare lymphoma affecting the fatty tissue under the skin caused by abnormal T-cells that has not achieved remission. C86.30 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, C86.30 maps to Lymphoma and Other Cancers (HCC 19) with a community, non-dual, aged base RAF weight of 0.105. Under the older V24 model, C86.30 mapped to the same category but with a base RAF weight of 0.675 — V28 recalibrated weights across the entire model. 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 active disease status and lack of remission in documentation. Because C86.30 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 C86.30 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify active disease status and lack of remission in documentation
- •Distinguish from C86.31 which indicates remission
Clinical Significance
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare cutaneous lymphoma that infiltrates subcutaneous adipose tissue, mimicking panniculitis on clinical presentation. It typically presents with multiple subcutaneous nodules and may be complicated by hemophagocytic syndrome, a life-threatening condition. When remission is not achieved, the disease may follow an indolent or aggressive course depending on the T-cell receptor phenotype (alpha-beta versus gamma-delta).
Documentation Requirements
- ✓Documentation must confirm the SPTCL diagnosis through deep skin biopsy including subcutaneous fat with immunophenotyping.
- ✓T-cell receptor phenotype (alpha-beta versus gamma-delta) should be documented as it affects prognosis.
- ✓Assessment for hemophagocytic syndrome, disease extent, treatment response, and active disease status must be recorded.