C92.12
BillableChronic myeloid leukemia, BCR/ABL-positive, in relapse
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C92.12 an HCC code?
Yes. C92.12 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 C92.12
For C92.12 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 C92.12 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C92.12 is the ICD-10-CM diagnosis code for chronic myeloid leukemia, bcr/abl-positive, in relapse. A type of blood cancer (chronic myeloid leukemia) with a specific genetic mutation that has returned after initial treatment. C92.12 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, C92.12 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, C92.12 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.
Verify BCR/ABL positivity is documented in the pathology report before assigning this code. Because C92.12 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 C92.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify BCR/ABL positivity is documented in the pathology report before assigning this code
- •Ensure relapse status is clearly documented; do not assume relapse without explicit physician documentation
Clinical Significance
Chronic myeloid leukemia, BCR/ABL-positive, in relapse indicates loss of previously achieved treatment response, which may manifest as hematologic, cytogenetic, or molecular relapse. CML relapse while on TKI therapy may indicate development of resistance mutations (e.g., T315I) and often requires switching to an alternative TKI or consideration of allogeneic transplant. Relapse after TKI discontinuation during treatment-free remission is also captured by this code.
Documentation Requirements
- ✓Documentation must confirm prior remission and evidence of relapse, including rising BCR-ABL1 transcript levels, loss of cytogenetic response, or hematologic recurrence.
- ✓BCR-ABL1 kinase domain mutation testing should be documented at relapse to guide TKI selection.
- ✓Current disease phase (chronic, accelerated, blast crisis) must be specified, as some relapses present with disease acceleration.