What is ICD-10 code C95.12?

C95.12 is the ICD-10-CM diagnosis code for Chronic leukemia of unspecified cell type, in relapse. A chronic leukemia of unknown cell type that has returned after a period of remission. It belongs to the ICD-10-CM chapter for neoplasms (c00-d49). C95.12 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. C95.12 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. C95.12 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. C95.12 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for C95.12?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For C95.12, V28 maps to Bladder, Colorectal, and Other Cancers at RAF 0.363 while V24 mapped to Lymphoma and Other Cancers at RAF 0.675. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting C95.12?

Document that the patient was previously in remission before the relapse occurred Chronic leukemia relapses may be managed differently than acute leukemia relapses; ensure treatment plan is documented Because C95.12 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM C95.12: Chronic leukemia

ICD-10-CM Code View

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Code lookupC95.12Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81-C96)

C95.12

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Chronic leukemia of unspecified cell type, in relapse

A chronic leukemia of unknown cell type that has returned after a period of remission.

Buddy Insight

Chronic leukemia of unspecified cell type in relapse indicates recurrence of a chronic leukemia whose lineage was never determined.

CMS-HCC V28

Mapped

HCC 22

Bladder, Colorectal, and Othe...

RAF 0.363

CMS-HCC V24

Mapped

HCC 10

Lymphoma and Other Cancers

RAF 0.675

ACA/HHS

Mapped

HCC 10

HHS-HCC 10

Varies by metal level

ESRD/PACE

Mapped

HCC 10

Lymphoma and Other Cancers

RAF 0.111

RXHCC

Mapped

HCC 19

Lymphoma and Other Cancers

RAF 1.949

Code Book Path

Official

C95Leukemia of unspecified cell type

C95.1Chronic leukemia of unspecified cell type

C95.12Chronic leukemia of unspecified cell type, in relapse

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C95.12 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C95.12 in this effective period.

Related Child Codes

Official

C95.10Chronic leukemia of unspecified cell type not having achieved remission

C95.11Chronic leukemia of unspecified cell type, in remission

Includes

Official

ICD-10-CM does not list Includes notes for C95.12 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C95.12 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C95.12 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C95.12 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C95.12 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation must establish prior remission followed by disease recurrence, with objective evidence of relapsed disease.

At relapse, renewed efforts to characterize the cell type should be documented, as targeted therapies for chronic leukemias are often lineage-specific.

MEAT Support

HCC Buddy guidance

Documentation must establish prior remission followed by disease recurrence, with objective evidence of relapsed disease.

At relapse, renewed efforts to characterize the cell type should be documented, as targeted therapies for chronic leukemias are often lineage-specific.

Audit Caution

HCC Buddy guidance

At relapse, reassess whether the chronic leukemia can now be classified by lineage, as this information is critical for salvage therapy selection.

Document whether the relapse involves transformation to acute leukemia, which would change the code to an acute leukemia category.

Distinguish relapse from disease progression.

Common Mistakes

HCC Buddy guidance

C95.10 (not achieved remission) applies to primary treatment failure.

C91.12, C92.12, and C93.12 should be used when specific chronic leukemia types are identified at relapse.

C95.02 is the acute counterpart in relapse.

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 C95.12 an HCC code?

Yes. C95.12 (Chronic leukemia of unspecified cell type, in relapse) maps to Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model (and Lymphoma and Other Cancers under V24), with a community non-dual aged RAF of 0.363. It is billable for payment year 2026.

Coder answer: C95.12 is billable and maps to V28 HCC 22, Bladder, Colorectal, and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: C95.12
Description: Chronic leukemia of unspecified cell type, in relapse
HCC (V28): HCC 22 — Bladder, Colorectal, and Other Cancers
RAF: 0.363
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 22, Bladder, Colorectal, and Other Cancers

0.363

V24HCC 10, Lymphoma and Other Cancers

0.675

ESRDHCC 10, Lymphoma and Other Cancers

0.111

RxHCCHCC 19, Lymphoma and Other Cancers

1.949

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work C95.12 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for C95.12

For C95.12 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 C95.12 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

C95.12 is the ICD-10-CM diagnosis code for chronic leukemia of unspecified cell type, in relapse. A chronic leukemia of unknown cell type that has returned after a period of remission. C95.12 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, C95.12 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.363. Under the older CMS-HCC V24 model, C95.12 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.

Document that the patient was previously in remission before the relapse occurred. Because C95.12 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 C95.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document that the patient was previously in remission before the relapse occurred
•Chronic leukemia relapses may be managed differently than acute leukemia relapses; ensure treatment plan is documented

Clinical Significance

Chronic leukemia of unspecified cell type in relapse indicates recurrence of a chronic leukemia whose lineage was never determined. Relapse in chronic leukemias may manifest as rising blood counts, recurrent lymphadenopathy, or transformation to a more aggressive disease form.

Documentation Requirements

✓Documentation must establish prior remission followed by disease recurrence, with objective evidence of relapsed disease.
✓At relapse, renewed efforts to characterize the cell type should be documented, as targeted therapies for chronic leukemias are often lineage-specific.

Commonly Confused Codes

•C95.10 (not achieved remission) applies to primary treatment failure.
•C91.12, C92.12, and C93.12 should be used when specific chronic leukemia types are identified at relapse.
•C95.02 is the acute counterpart in relapse.