What is ICD-10 code C92.11?

C92.11 is the ICD-10-CM diagnosis code for Chronic myeloid leukemia, BCR/ABL-positive, in remission. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C92.11 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C92.11 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. C92.11 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. C92.11 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does C92.11 map to under V28?

C92.11 maps to CMS-HCC V28 22 (Bladder, Colorectal, and Other Cancers). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does C92.11 pay in RAF?

C92.11 carries a community, non-dual, aged (CNA) RAF weight of 0.363 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for C92.11?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For C92.11, V28 maps to Bladder, Colorectal, and Other Cancers at RAF 0.363 while V24 mapped to Lung and Other Severe Cancers at RAF 1.024. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports C92.11?

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 Because C92.11 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM C92.11: Chronic myeloid

C92.11 maps to CMS-HCC V28 22 (RAF 0.363). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupC92.11Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81-C96)

C92.11

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

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.

Buddy Insight

CMS-HCC V28

Mapped

HCC 22

Bladder, Colorectal, and Othe...

RAF 0.363

CMS-HCC V24

Mapped

HCC 9

Lung and Other Severe Cancers

RAF 1.024

ACA/HHS

Mapped

HCC 9

HHS-HCC 9

Varies by metal level

ESRD/PACE

Mapped

HCC 9

Lung and Other Severe Cancers

RAF 0.181

RXHCC

Mapped

HCC 15

Chronic Myeloid Leukemia

RAF 6.175

Code Book Path

Official

C92Myeloid leukemia

C92.1Chronic myeloid leukemia, BCR/ABL-positive

C92.11Chronic myeloid leukemia, BCR/ABL-positive, in remission

Inclusion Terms

Official

Chronic myelogenous leukemia, Philadelphia chromosome (Ph1) positive
Chronic myelogenous leukemia, t(9;22) (q34;q11)
Chronic myelogenous leukemia with crisis of blast cells

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C92.11 in this effective period.

Related Child Codes

Official

C92.10Chronic myeloid leukemia, BCR/ABL-positive, not having achieved remission

C92.12Chronic myeloid leukemia, BCR/ABL-positive, in relapse

Includes

Official

ICD-10-CM does not list Includes notes for C92.11 in this effective period.

Excludes 1

Official

atypical chronic myeloid leukemia BCR/ABL-negative (C92.2-)
chronic myelomonocytic leukemia (C93.1-)
chronic myeloproliferative disease (D47.1)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C92.11 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C92.11 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C92.11 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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.

MEAT Support

HCC Buddy guidance

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.

Audit Caution

HCC Buddy guidance

The definition of 'remission' in CML has evolved with TKI therapy. Complete hematologic response alone may not constitute remission per current standards -

major molecular response (MMR, BCR-ABL1 less than 0.1% IS) or deeper is typically expected. Patients discontinuing TKI therapy who maintain molecular remission are still coded as CML in remission, not as cured. Loss of MMR after TKI discontinuation requires prompt reclassification.

Common Mistakes

HCC Buddy guidance

C92.10 (CML not in remission) is for active or suboptimally responding disease.

C92.12 (CML in relapse) is for loss of response.

C92.21 (atypical CML, BCR/ABL-negative, in remission) is a distinct entity.

Z85.6 (personal history of leukemia) should not be used while the patient remains on TKI therapy or in treatment-free remission monitoring.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is C92.11 an HCC code?

Yes. C92.11 (Chronic myeloid leukemia, BCR/ABL-positive, in remission) maps to Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model (and Lung and Other Severe Cancers under V24), with a community non-dual aged RAF of 0.363. It is billable for payment year 2026.

Coder answer: C92.11 is billable and maps to V28 HCC 22, Bladder, Colorectal, and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: C92.11
Description: Chronic myeloid leukemia, BCR/ABL-positive, in remission
HCC (V28): HCC 22 — Bladder, Colorectal, and Other Cancers
RAF: 0.363
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 22, Bladder, Colorectal, and Other Cancers

0.363

V24HCC 9, Lung and Other Severe Cancers

1.024

ESRDHCC 9, Lung and Other Severe Cancers

0.181

RxHCCHCC 15, Chronic Myeloid Leukemia

6.175

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work C92.11 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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 Bladder, Colorectal, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.363. 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 1.024. 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.

Commonly Confused Codes

•C92.10 (CML not in remission) is for active or suboptimally responding disease.
•C92.12 (CML in relapse) is for loss of response.
•C92.21 (atypical CML, BCR/ABL-negative, in remission) is a distinct entity.
•Z85.6 (personal history of leukemia) should not be used while the patient remains on TKI therapy or in treatment-free remission monitoring.