C94.01
BillableAcute erythroid leukemia, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C94.01 an HCC code?
Yes. C94.01 maps to Metastatic Cancer and Acute Leukemia 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 C94.01
For C94.01 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 C94.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C94.01 is the ICD-10-CM diagnosis code for acute erythroid leukemia, in remission. A rare type of blood cancer where cancer cells develop from red blood cell precursors and the cancer has responded to treatment. C94.01 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, C94.01 maps to Metastatic Cancer and Acute Leukemia (HCC 17) with a community, non-dual, aged base RAF weight of 0.368. Under the older V24 model, C94.01 mapped to the same category but with a base RAF weight of 2.484 — V28 recalibrated weights across the entire model. 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.
Confirm pathology diagnosis of acute erythroid leukemia; this is a rare subtype requiring specific identification. Because C94.01 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 C94.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm pathology diagnosis of acute erythroid leukemia; this is a rare subtype requiring specific identification
- •The fifth character '1' indicates remission; document the remission status clearly in the medical record
Clinical Significance
Acute erythroid leukemia in remission indicates this rare erythroid-lineage leukemia has responded to intensive chemotherapy. Given the rarity and aggressive nature of this subtype, achieving remission often requires combination chemotherapy similar to other acute myeloid leukemia protocols, and long-term survival remains guarded.
Documentation Requirements
- ✓Documentation must explicitly confirm remission, supported by bone marrow biopsy showing less than 5% blasts and normalized erythropoiesis.
- ✓The specific remission criteria met (complete vs.
- ✓partial), date of remission, and ongoing surveillance or consolidation therapy plan must be recorded.