C92.10
BillableChronic myeloid leukemia, BCR/ABL-positive, not having achieved remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C92.10 an HCC code?
Yes. C92.10 maps to Colorectal, Bladder, 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 C92.10
For C92.10 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 C92.10 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C92.10 is the ICD-10-CM diagnosis code for chronic myeloid leukemia, bcr/abl-positive, not having achieved remission. A chronic blood cancer of myeloid cells with a specific genetic abnormality (BCR/ABL fusion) that has not achieved remission. C92.10 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, C92.10 maps to Colorectal, Bladder, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.000. Under the older CMS-HCC V24 model, C92.10 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.
This code requires documentation of BCR/ABL positivity, typically confirmed by cytogenetics or molecular testing. Because C92.10 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 C92.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code requires documentation of BCR/ABL positivity, typically confirmed by cytogenetics or molecular testing
- •The BCR/ABL mutation is the hallmark of chronic myeloid leukemia and must be documented
Clinical Significance
Chronic myeloid leukemia (CML), BCR/ABL-positive, is a myeloproliferative neoplasm characterized by the Philadelphia chromosome (t(9;22)) creating the BCR-ABL1 fusion oncogene. The 'not in remission' status indicates detectable disease activity, which in the tyrosine kinase inhibitor (TKI) era may range from suboptimal molecular response to blast crisis. CML has three phases (chronic, accelerated, blast crisis) with dramatically different prognoses.
Documentation Requirements
- ✓Documentation must confirm BCR/ABL positivity by cytogenetics (Philadelphia chromosome), FISH, or molecular testing (BCR-ABL1 by PCR).
- ✓Current disease phase (chronic, accelerated, blast crisis) and treatment response should be documented using established milestones (complete hematologic response, complete cytogenetic response, major molecular response).
- ✓Current TKI therapy and tolerance/resistance issues must be recorded.
Commonly Confused Codes
- •C92.20 (atypical CML, BCR/ABL-negative) is a distinct entity without the Philadelphia chromosome.
- •C92.00 (acute myeloblastic leukemia) should be used instead if CML has transformed to blast crisis with myeloid phenotype.
- •C92.90 (myeloid leukemia, unspecified) should not be used when CML is specifically diagnosed.
- •D47.1 (chronic myeloproliferative disease, not elsewhere classified) is a different category.