C90.02
BillableMultiple myeloma in relapse
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C90.02 an HCC code?
Yes. C90.02 maps to Lymphoma and Other Cancers under the CMS-HCC V28 risk adjustment model (and Lung and Other Severe 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 C90.02
For C90.02 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 C90.02 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C90.02 is the ICD-10-CM diagnosis code for multiple myeloma in relapse. Multiple myeloma that has returned or worsened after a period of remission or improvement. C90.02 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, C90.02 maps to Lymphoma and Other Cancers (HCC 19) with a community, non-dual, aged base RAF weight of 0.105. Under the older CMS-HCC V24 model, C90.02 maps to Lung and Other Severe Cancers (HCC 9) with a community, non-dual, aged base RAF weight of 0.973. 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.
Relapse (fifth character '2') indicates the cancer has returned after remission; distinguish from initial diagnosis. Because C90.02 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 C90.02 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Relapse (fifth character '2') indicates the cancer has returned after remission; distinguish from initial diagnosis
- •Document the timeline of remission and relapse to support medical necessity for treatment decisions
Clinical Significance
Multiple myeloma in relapse indicates the disease has returned after a period of remission, with rising monoclonal protein levels, reappearance of bone marrow plasmacytosis, or recurrence of end-organ damage. Relapsed myeloma typically requires a change in treatment regimen, as the disease may have developed resistance to prior therapy. Each successive relapse generally portends a shorter subsequent remission duration.
Documentation Requirements
- ✓Documentation must include evidence of biochemical or clinical relapse based on IMWG criteria, such as rising monoclonal protein, new bone lesions, worsening anemia, or hypercalcemia.
- ✓The timeline from prior remission to relapse, prior treatment regimens, new treatment plan, and current disease burden must be documented.