C95.10
BillableChronic leukemia of unspecified cell type not having achieved remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C95.10 an HCC code?
Yes. C95.10 maps to Colorectal, Bladder, and Other Cancers under the CMS-HCC V28 risk adjustment model (and Lymphoma and Other 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 C95.10
For C95.10 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 C95.10 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C95.10 is the ICD-10-CM diagnosis code for chronic leukemia of unspecified cell type not having achieved remission. A chronic leukemia of unknown cell type that has not responded to treatment or achieved remission. C95.10 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, C95.10 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, C95.10 maps to Lymphoma and Other Cancers (HCC 10) with a community, non-dual, aged base RAF weight of 0.675. 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 the chronic nature of the leukemia in documentation; chronic leukemias typically progress more slowly than acute types. Because C95.10 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 C95.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Chronic leukemia of unspecified cell type not having achieved remission is used when a chronic leukemia is confirmed but the specific cell lineage cannot be determined from available documentation. Chronic leukemias typically have a more indolent course than acute forms, but unspecified status limits treatment optimization.
Documentation Requirements
- ✓Documentation should confirm the chronic nature of the leukemia through clinical course and pathologic findings, while explaining why the cell type remains unspecified.
- ✓Diagnostic workup attempted (flow cytometry, cytogenetics, molecular studies) should be documented.
- ✓Treatment status confirming no remission must be recorded.
Commonly Confused Codes
- •C91.10 (chronic lymphocytic leukemia), C92.10 (chronic myeloid leukemia), and C93.10 (chronic myelomonocytic leukemia) should be used when specific lineage is identified.
- •C95.00 (acute leukemia, unspecified) is the acute counterpart.
- •C95.90 (leukemia, unspecified) does not distinguish acute from chronic.