C94.82
BillableOther specified leukemias, in relapse
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C94.82 an HCC code?
Yes. C94.82 maps to Lung and Other Severe 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 C94.82
For C94.82to 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 C94.82 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C94.82 is the ICD-10-CM diagnosis code for other specified leukemias, in relapse. A rare type of leukemia that has returned after a period of remission. C94.82 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, C94.82 maps to Lung and Other Severe Cancers (HCC 20) with a community, non-dual, aged base RAF weight of 1.136. Under the older V24 model, C94.82 mapped to the same category but with a base RAF weight of 1.024 — 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.
Relapse indicates the cancer has recurred after achieving remission; ensure documentation supports this status. Because C94.82 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 C94.82 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Relapse indicates the cancer has recurred after achieving remission; ensure documentation supports this status
- •Do not confuse relapse with initial failure to achieve remission (C94.80)
Clinical Significance
Other specified leukemias in relapse indicates recurrence of a rare or atypical leukemia type after prior remission. Relapsed atypical leukemias present formidable clinical challenges due to limited experience with salvage protocols and often require tertiary center referral for specialized management.
Documentation Requirements
- ✓Documentation must establish prior remission followed by disease recurrence, with updated diagnostic studies confirming the relapsed nature.
- ✓Any changes in the leukemia phenotype or genotype at relapse should be noted, as clonal evolution may alter the disease classification and treatment approach.