C88.01
BillableWaldenström macroglobulinemia, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C88.01 an HCC code?
Yes. C88.01 maps to Breast, Prostate, Colorectal and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model (and Other Significant Endocrine and Metabolic Disorders 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 C88.01
For C88.01 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 C88.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C88.01 is the ICD-10-CM diagnosis code for waldenström macroglobulinemia, in remission. A rare blood cancer where abnormal plasma cells produce excessive immunoglobulin M protein, and the disease has responded well to treatment with no active disease. C88.01 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, C88.01 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, C88.01 maps to Other Significant Endocrine and Metabolic Disorders (HCC 23) with a community, non-dual, aged base RAF weight of 0.230. 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 remission is documented; verify remission criteria met before coding. Because C88.01 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 C88.01 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 remission is documented; verify remission criteria met before coding
- •Track duration of remission and any subsequent relapse for accurate disease monitoring
Clinical Significance
Waldenstrom macroglobulinemia in remission indicates the lymphoplasmacytic lymphoma has responded to treatment with significant reduction or normalization of the monoclonal immunoglobulin M level. Remission may be partial or complete, and the indolent nature of this disease means patients may remain in remission for extended periods. Ongoing monitoring of immunoglobulin M levels and bone marrow status is essential for early relapse detection.
Documentation Requirements
- ✓Provider must explicitly document remission with supporting laboratory evidence including reduced immunoglobulin M levels, improved hemoglobin, and possibly bone marrow biopsy showing decreased lymphoplasmacytic infiltrate.
- ✓Surveillance schedule with serial serum protein electrophoresis and immunoglobulin M quantification should be documented.
Commonly Confused Codes
- •C88.00 (Waldenstrom macroglobulinemia not in remission) indicates active disease.
- •Z85.79 (personal history of malignant neoplasm of lymphoid tissue) is only for definitively cured disease.
- •D47.2 (monoclonal gammopathy of undetermined significance) should not be used as a substitute for Waldenstrom in remission.