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C95.91 ICD-10-CM Code: Leukemia, unspecified, in remission

C95.91 maps to CMS-HCC V28 22. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

HCC Buddy Code Card

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

C95.91

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

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.

Buddy the Bee presenting code insight

Buddy Insight

Leukemia, unspecified, in remission represents the uncommon scenario where a leukemia achieved remission without ever having its specific type determined.

CMS-HCC V28

HCC 22

Code-level coefficient reference

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 010

Code-level coefficient reference

ESRD/PACE

HCC 10

Code-level coefficient reference

RXHCC

HCC 19

Code-level coefficient reference

Code Book Path

Official
C95Leukemia of unspecified cell type
C95.9Leukemia, unspecified
C95.91Leukemia, unspecified, in remission

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for C95.91 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for C95.91 in this effective period.

Related Child Codes

Official
C95.90Leukemia, unspecified not having achieved remission
C95.92Leukemia, unspecified, in relapse

Includes

Official

ICD-10-CM does not list Includes notes for C95.91 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for C95.91 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for C95.91 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for C95.91 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for C95.91 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
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.

MEAT Support

HCC Buddy guidance
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.

Audit Caution

HCC Buddy guidance
This code should be extremely rare
review the entire medical record for any prior pathology, flow cytometry, or molecular data that could enable more specific coding. Even historical records from another facility may provide the needed specificity. Query the provider about the original diagnostic workup.

Common Mistakes

HCC Buddy guidance
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.

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 C95.91 an HCC code?

Yes. C95.91 (Leukemia, unspecified, in remission) maps to HCC 22, Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.363. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: C95.91 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
C95.91
Description
Leukemia, unspecified, in remission
HCC (V28)
HCC 22 — Bladder, Colorectal, and Other Cancers
RAF reference coefficient
0.363
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 22, Bladder, Colorectal, and Other Cancers
0.363
ESRDHCC 10, Lymphoma and Other Cancers
Not separately weighted
RxHCCHCC 19, Leukemias and Other Hematologic Cancers
Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work C95.91 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

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.

Coder workflow notes

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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 Bladder, Colorectal, and Other Cancers (HCC 22) with a source-labeled community, non-dual, aged reference coefficient of 0.363. No V24 mapping is shown for C95.91; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Only assign this code when documentation explicitly states the patient is in remission. Because C95.91 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, 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.

Child Codes

C95.90Leukemia, unspecified not having achieved remission
HCC 22
C95.91Leukemia, unspecified, in remission
HCC 22
C95.92Leukemia, unspecified, in relapse
HCC 22

Code Hierarchy

└C95Leukemia of unspecified cell type└C95.9Leukemia, unspecified└C95.91Leukemia, unspecified, in remission
└C95.91Leukemia, unspecified, in remission

Because C95.91 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment.

C95.91 maps to CMS-HCC V28 category 22, Bladder, Colorectal, and Other Cancers. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for C95.91. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

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