C86.60
BillablePrimary cutaneous CD30-positive T-cell proliferations not having achieved remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C86.60 an HCC code?
Yes. C86.60 maps to Lung and Other Severe 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 C86.60
For C86.60 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 C86.60 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C86.60 is the ICD-10-CM diagnosis code for primary cutaneous cd30-positive t-cell proliferations not having achieved remission. A rare skin lymphoma caused by abnormal T-cells with CD30 markers that has not achieved remission. C86.60 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, C86.60 maps to Lung and Other Severe Cancers (HCC 20) with a community, non-dual, aged base RAF weight of 0.000. Under the older CMS-HCC V24 model, C86.60 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 CD30-positive status is confirmed in pathology report. Because C86.60 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 C86.60 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify CD30-positive status is confirmed in pathology report
- •Ensure active disease status is documented and remission has not been achieved
Clinical Significance
Primary cutaneous CD30-positive T-cell proliferations represent a spectrum of skin lymphomas including lymphomatoid papulosis and primary cutaneous anaplastic large cell lymphoma. These disorders are characterized by CD30 antigen expression on the malignant T-cells and generally have a more favorable prognosis than systemic CD30-positive lymphomas. Non-remission status indicates ongoing active skin disease that has not responded fully to therapy.
Documentation Requirements
- ✓Documentation must include skin biopsy with immunohistochemistry confirming CD30 positivity on T-cell infiltrates.
- ✓The specific entity within the CD30-positive spectrum should be documented if identified.
- ✓Extent of skin involvement, treatment modality (radiation, methotrexate, brentuximab), response assessment, and active disease status must be recorded.
Commonly Confused Codes
- •C86.61 (same condition in remission) requires documented remission.
- •C84.6x (anaplastic large cell lymphoma, ALK-positive) is a systemic entity distinct from primary cutaneous CD30-positive disease.
- •C84.A (cutaneous T-cell lymphoma, unspecified) is less specific and should not be used when CD30-positive status is confirmed.