C94.20 ICD-10-CM Code: Acute megakaryoblastic leukemia not having achieved remission
C94.20 maps to CMS-HCC V28 17. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
HCC Buddy Code Card
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FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81-C96)
C94.20
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAcute megakaryoblastic leukemia not having achieved remission
A rare blood cancer where immature megakaryoblasts (cells that produce platelets) multiply uncontrollably and have not responded to treatment.
Buddy Insight
Acute megakaryoblastic leukemia not having achieved remission is a rare subtype of acute myeloid leukemia where malignant cells derive from the megakaryocyte (platelet-producing) lineage.
CMS-HCC V28
MappedHCC 17
Coefficient HCC 17: 4.209 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 008
Code-level coefficient reference
ESRD/PACE
MappedHCC 8
Code-level coefficient reference
RXHCC
MappedHCC 19
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Acute megakaryoblastic leukemia with failed remission
- Acute megakaryoblastic leukemia NOS
- Acute myeloid leukemia M7Inherited from C94.2
- Acute megakaryocytic leukemiaInherited from C94.2
Excludes 2
Official- Kaposi's sarcoma of lymph nodes (C46.3)Inherited from C81-C96
- secondary and unspecified neoplasm of lymph nodes (C77.-)Inherited from C81-C96
- secondary neoplasm of bone marrow (C79.52)Inherited from C81-C96
- secondary neoplasm of spleen (C78.89)Inherited from C81-C96
Related Codes
Includes
OfficialNo Includes notes are included in this display for C94.20. Check the code and parent instructions in the Code Book.
Excludes 1
Official- leukemic reticuloendotheliosis (C91.4-)Inherited from C94
- myelodysplastic syndromes (D46.-)Inherited from C94
- personal history of leukemia (Z85.6)Inherited from C94
- plasma cell leukemia (C90.1-)Inherited from C94
Code First
OfficialNo Code First sequencing instructions are included in this display for C94.20. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for C94.20. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for C94.20. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 C94.20 an HCC code?
Yes. C94.20 (Acute megakaryoblastic leukemia not having achieved remission) maps to HCC 17, Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 4.209. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: C94.20 is billable and maps to V28 HCC 17, Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- C94.20
- Description
- Acute megakaryoblastic leukemia not having achieved remission
- HCC (V28)
- HCC 17 — Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic
- RAF reference coefficient
- 4.209
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work C94.20 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for C94.20
For C94.20, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
C94.20 is the ICD-10-CM diagnosis code for acute megakaryoblastic leukemia not having achieved remission. A rare blood cancer where immature megakaryoblasts (cells that produce platelets) multiply uncontrollably and have not responded to treatment. C94.20 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, C94.20 maps to Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic (HCC 17) with a source-labeled community, non-dual, aged reference coefficient of 4.209. No V24 mapping is shown for C94.20; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Use this code when documentation indicates the patient has not achieved remission after initial treatment. For C94.20, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for C94.20 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Acute megakaryoblastic leukemia not having achieved remission is a rare subtype of acute myeloid leukemia where malignant cells derive from the megakaryocyte (platelet-producing) lineage. It is most commonly seen in children with Down syndrome and in adults often presents with significant bone marrow fibrosis, making diagnosis challenging.
Documentation Requirements
- ✓Diagnosis requires bone marrow biopsy with immunophenotyping demonstrating megakaryocytic markers (CD41, CD61, CD42). Documentation should include blast morphology findings, myelofibrosis status, cytogenetic results (particularly t(1
- ✓22) in infants), and confirmation that remission has not been achieved.
Commonly Confused Codes
- •D47.3 (essential thrombocythemia) involves megakaryocytes but is a chronic myeloproliferative neoplasm, not acute leukemia.
- •C94.40 (acute panmyelosis with myelofibrosis) also features myelofibrosis but involves all cell lineages.
- •C92.00 (acute myeloblastic leukemia) lacks specific megakaryocytic differentiation.