C95.12
BillableChronic leukemia of unspecified cell type, in relapse
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C95.12 an HCC code?
Yes. C95.12 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 C95.12
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.
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 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, C95.12 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.