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C95.92 ICD-10-CM Code: Leukemia, unspecified, in relapse

C95.92 maps to CMS-HCC V28 22. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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Code lookupC95.92

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

C95.92

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

Leukemia, unspecified, in relapse

A type of blood cancer (leukemia) of unknown cell type that has returned or worsened after a period of remission.

Buddy the Bee presenting code insight

Buddy Insight

Leukemia, unspecified, in relapse indicates recurrence of a leukemia whose type was never determined, following a period of remission.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 22

Coefficient HCC 22: 0.363 (Community Non-Dual Aged (CNA))

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 typeC95.9Leukemia, unspecifiedC95.92Leukemia, unspecified, in relapse

Inclusion Terms

Official

No inclusion terms are included in this display for C95.92. Check the code and parent instructions in the Code Book.

Excludes 2

Official
  • Kaposi's sarcoma of lymph nodes (C46.3)Inherited from C81-C96
  • secondary and unspecified neoplasm of lymph nodes (C77.-)Inherited from C81-C96
  • secondary neoplasm of bone marrow (C79.52)Inherited from C81-C96
  • secondary neoplasm of spleen (C78.89)Inherited from C81-C96

Related Codes

Official
C95.90Leukemia, unspecified not having achieved remissionC95.91Leukemia, unspecified, in remission

Includes

Official

No Includes notes are included in this display for C95.92. Check the code and parent instructions in the Code Book.

Excludes 1

Official
  • personal history of leukemia (Z85.6)Inherited from C95

Code First

Official

No Code First sequencing instructions are included in this display for C95.92. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for C95.92. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for C95.92. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
Documentation must confirm prior remission followed by disease recurrence.
At relapse, comprehensive diagnostic workup (flow cytometry, cytogenetics, molecular studies) should be performed and documented to finally characterize the leukemia type.
Current disease status and treatment approach should be recorded.

MEAT Support

HCC Buddy guidance
Documentation must confirm prior remission followed by disease recurrence.
At relapse, comprehensive diagnostic workup (flow cytometry, cytogenetics, molecular studies) should be performed and documented to finally characterize the leukemia type.
Current disease status and treatment approach should be recorded.

Audit Caution

HCC Buddy guidance
Relapse provides a critical opportunity to perform definitive diagnostic studies and assign a specific leukemia code.
This unspecified relapse code should only persist temporarily while awaiting diagnostic results.
Payers will likely query this code and may require additional documentation.

Common Mistakes

HCC Buddy guidance
C95.90 (not achieved remission) applies to primary treatment failure.
C95.02 (acute, unspecified, in relapse) and C95.12 (chronic, unspecified, in relapse) provide more specificity.
Any specific leukemia code with relapse suffix is preferred over this fully unspecified code.

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 C95.92 an HCC code?

Yes. C95.92 (Leukemia, unspecified, in relapse) 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: C95.92 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
C95.92
Description
Leukemia, unspecified, in relapse
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 C95.92 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for C95.92

For C95.92, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

  • 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

Coder workflow notes

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What This Code Means

C95.92 is the ICD-10-CM diagnosis code for leukemia, unspecified, in relapse. A type of blood cancer (leukemia) of unknown cell type that has returned or worsened after a period of remission. C95.92 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, C95.92 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 C95.92; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.

Relapse indicates the cancer has recurred after achieving remission; ensure documentation supports this status. For C95.92, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 C95.92 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Relapse indicates the cancer has recurred after achieving remission; ensure documentation supports this status
  • •Do not confuse relapse with initial presentation or failure to achieve remission

Clinical Significance

Leukemia, unspecified, in relapse indicates recurrence of a leukemia whose type was never determined, following a period of remission. This scenario presents an urgent need for comprehensive diagnostic evaluation at the time of relapse to guide appropriate salvage therapy.

Documentation Requirements

  • ✓Documentation must confirm prior remission followed by disease recurrence.
  • ✓At relapse, comprehensive diagnostic workup (flow cytometry, cytogenetics, molecular studies) should be performed and documented to finally characterize the leukemia type.
  • ✓Current disease status and treatment approach should be recorded.

Commonly Confused Codes

  • •C95.90 (not achieved remission) applies to primary treatment failure.
  • •C95.02 (acute, unspecified, in relapse) and C95.12 (chronic, unspecified, in relapse) provide more specificity.
  • •Any specific leukemia code with relapse suffix is preferred over this fully unspecified code.

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└C95.92Leukemia, unspecified, in relapse
└C95.92Leukemia, unspecified, in relapse

Also searched as

  • C95 92
  • C9592

For C95.92, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

C95.92 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 C95.92. 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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