D03.0
BillableMelanoma in situ of lip
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D03.0 an HCC code?
Yes. D03.0 maps to Melanoma and Other Skin Cancers under the CMS-HCC V28 risk adjustment model (and Breast, Prostate, and Other Cancers and Tumors 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 D03.0
For D03.0 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 D03.0 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D03.0 is the ICD-10-CM diagnosis code for melanoma in situ of lip. Abnormal melanoma cells on the lip that have not yet invaded deeper layers of tissue. D03.0 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering in situ neoplasms (d00-d09).
Under the CMS-HCC V28 risk adjustment model, D03.0 maps to Melanoma and Other Skin Cancers (HCC 23) with a community, non-dual, aged base RAF weight of 0.251. Under the older CMS-HCC V24 model, D03.0 maps to Breast, Prostate, and Other Cancers and Tumors (HCC 12) with a community, non-dual, aged base RAF weight of 0.150. 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.
Melanoma in situ on the lip requires careful documentation to distinguish from other lip lesions. Because D03.0 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 D03.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Melanoma in situ on the lip requires careful documentation to distinguish from other lip lesions
- •This is an early-stage melanoma with better prognosis if treated appropriately
Clinical Significance
Melanoma in situ of the lip represents stage 0 melanoma confined to the epidermal layer without dermal invasion, representing the earliest detectable form of melanocytic malignancy at this anatomical site. The lip is a sun-exposed area where melanoma in situ can be challenging to distinguish from other pigmented lesions such as melanotic macules or labial lentigo. Early detection and complete excision offer a near 100% cure rate.
Documentation Requirements
- ✓Pathologic confirmation via biopsy is essential, documenting that the atypical melanocytes are confined to the epidermis without dermal invasion.
- ✓The exact anatomical location on the lip (upper vs.
- ✓lower, vermilion border vs.
- ✓skin) and the margin status after excision should be recorded.
- ✓Documentation of dermoscopic findings and the clinical differential diagnosis supports medical necessity.