C95.90 ICD-10-CM Code: Leukemia, unspecified not having achieved remission
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Neoplasms (C00-D49) / Malignant neoplasms of lymphoid, hematopoietic and related tissue (C81-C96)
C95.90
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLeukemia, unspecified not having achieved remission
A type of blood cancer (leukemia) where the specific cell type is unknown and the cancer has not responded to treatment or gone into remission.
Buddy Insight
Leukemia, unspecified, not having achieved remission is the least specific leukemia code, used when neither the cell type nor the acute/chronic distinction can be determined.
CMS-HCC V28
MappedHCC 22
RAF 0.0
CMS-HCC V24
MappedHCC 10
RAF 0.675
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 10
RAF 0.0
RXHCC
MappedHCC 19
RAF 0.0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
Official- Leukemia, unspecified with failed remission
- Leukemia NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for C95.90 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for C95.90 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for C95.90 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for C95.90 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for C95.90 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for C95.90 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is C95.90 an HCC code?
Yes. C95.90 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 C95.90
For C95.90to 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 C95.90 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
C95.90 is the ICD-10-CM diagnosis code for leukemia, unspecified not having achieved remission. A type of blood cancer (leukemia) where the specific cell type is unknown and the cancer has not responded to treatment or gone into remission. C95.90 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, C95.90 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, C95.90 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.
Use this code when leukemia type is unspecified and documentation does not indicate remission status. Because C95.90 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 C95.90 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Leukemia, unspecified, not having achieved remission is the least specific leukemia code, used when neither the cell type nor the acute/chronic distinction can be determined. This code represents a significant documentation gap and should prompt immediate efforts to obtain diagnostic specificity.
Documentation Requirements
- ✓Documentation should explain why the leukemia remains completely unspecified and what diagnostic workup has been performed or is pending.
- ✓Peripheral blood and bone marrow findings, even if preliminary, should be documented.
- ✓Treatment initiated without definitive diagnosis and response status should be recorded.
Commonly Confused Codes
- •C95.00 (acute leukemia, unspecified) and C95.10 (chronic leukemia, unspecified) are preferred when the acute/chronic distinction is known.
- •Any specific leukemia code (C91.-, C92.-, C93.-, C94.-) should be used when the cell lineage is identified.
- •This code should rarely persist beyond the initial diagnostic workup.