C92.41
BillableAcute promyelocytic leukemia, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C92.41 an HCC code?
Yes. C92.41 maps to Colorectal, Bladder, and Other Cancers under the CMS-HCC V28 risk adjustment model (and Metastatic Cancer and Acute Leukemia 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 C92.41
For C92.41 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 C92.41 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C92.41 is the ICD-10-CM diagnosis code for acute promyelocytic leukemia, in remission. A rapidly developing blood cancer with abnormal promyelocytes that is currently in remission. C92.41 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, C92.41 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, C92.41 maps to Metastatic Cancer and Acute Leukemia (HCC 8) with a community, non-dual, aged base RAF weight of 2.484. 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.
Acute promyelocytic leukemia (APL) is a medical emergency; verify remission status is documented. Because C92.41 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 C92.41 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Acute promyelocytic leukemia (APL) is a medical emergency; verify remission status is documented
- •This subtype often responds well to targeted therapy; document treatment response
Clinical Significance
Acute promyelocytic leukemia in remission indicates successful response to ATRA-based therapy, which is achievable in over 90% of patients who survive the initial high-risk DIC period. Remission in APL is typically assessed by molecular testing showing undetectable PML-RARA transcripts by PCR. APL has the highest cure rate among AML subtypes, and patients achieving molecular remission after consolidation have excellent long-term outcomes.
Documentation Requirements
- ✓Documentation must confirm the PML-RARA-positive diagnosis and explicit remission status, ideally with molecular remission (undetectable PML-RARA by RT-PCR).
- ✓The treatment regimen (ATRA/arsenic trioxide or ATRA/chemotherapy), date of remission, and consolidation/maintenance plan should be recorded.
- ✓Molecular monitoring schedule during post-consolidation surveillance must be documented, typically every 3 months for 2 years.