C95.91
BillableLeukemia, unspecified, in remission
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is C95.91 an HCC code?
Yes. C95.91 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 C95.91
For C95.91 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 C95.91 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
C95.91 is the ICD-10-CM diagnosis code for leukemia, unspecified, in remission. A type of blood cancer (leukemia) of unknown cell type that is currently in remission, meaning the cancer is not detectable or has responded well to treatment. C95.91 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, C95.91 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, C95.91 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.
Only assign this code when documentation explicitly states the patient is in remission. Because C95.91 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 C95.91 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Only assign this code when documentation explicitly states the patient is in remission
- •Remission status must be clearly documented in the medical record to differentiate from C95.90
Clinical Significance
Leukemia, unspecified, in remission represents the uncommon scenario where a leukemia achieved remission without ever having its specific type determined. This may occur when treatment was initiated empirically, the patient transferred care with incomplete records, or early records were lost.
Documentation Requirements
- ✓Documentation must confirm remission status despite the inability to specify the leukemia type.
- ✓The reason for the lack of specificity should be explained.
- ✓Remission evidence such as normalized blood counts and bone marrow findings should be recorded, along with the ongoing surveillance plan.
Commonly Confused Codes
- •C95.01 (acute leukemia, unspecified, in remission) and C95.11 (chronic leukemia, unspecified, in remission) offer more specificity if the acute/chronic nature is known.
- •Z85.6 (personal history of leukemia) should not replace this active diagnosis code during surveillance.
- •Any specific leukemia code in remission is preferred.