C92.11
BillableChronic myeloid leukemia, BCR/ABL-positive, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C92.11 an HCC code?
Yes. C92.11 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 C92.11
For C92.11 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 C92.11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C92.11 is the ICD-10-CM diagnosis code for chronic myeloid leukemia, bcr/abl-positive, in remission. This is a type of blood cancer where bone marrow produces too many abnormal white blood cells due to a specific genetic mutation (BCR/ABL), but the disease is currently in remission, meaning cancer cells are not actively growing or are undetectable. C92.11 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, C92.11 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, C92.11 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.
Ensure documentation explicitly states 'in remission' status, as this fifth character is critical for accurate coding and affects treatment planning and prognosis tracking. Because C92.11 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 C92.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation explicitly states 'in remission' status, as this fifth character is critical for accurate coding and affects treatment planning and prognosis tracking
- •Verify the BCR/ABL-positive status is confirmed through cytogenetic or molecular testing before coding, as this distinguishes it from other myeloid leukemias and impacts targeted therapy eligibility
Clinical Significance
Chronic myeloid leukemia, BCR/ABL-positive, in remission indicates successful response to tyrosine kinase inhibitor therapy with achievement of complete cytogenetic response (CCyR) or deep molecular response. In the modern treatment era, many CML patients achieve sustained deep molecular responses, and select patients may be candidates for treatment-free remission (TKI discontinuation). Even in remission, lifelong monitoring is generally recommended.
Documentation Requirements
- ✓Documentation must confirm BCR/ABL positivity, remission status, and the level of response (complete hematologic, cytogenetic, or molecular response).
- ✓BCR-ABL1 transcript levels by quantitative PCR (IS scale) should be documented.
- ✓For patients in treatment-free remission, documentation of TKI discontinuation date and molecular monitoring frequency (monthly for first year, then quarterly) is essential.