D03.52
BillableMelanoma in situ of breast (skin) (soft tissue)
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D03.52 an HCC code?
Yes. D03.52 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 D03.52
For D03.52 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 D03.52 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
D03.52 is the ICD-10-CM diagnosis code for melanoma in situ of breast (skin) (soft tissue). Early-stage melanoma confined to the skin surface of the breast area, including both the skin and superficial soft tissue. D03.52 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, D03.52 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, D03.52 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.
Specify whether the melanoma is on the breast skin itself versus other chest wall locations. Because D03.52 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 D03.52 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Specify whether the melanoma is on the breast skin itself versus other chest wall locations
- •Document laterality (right vs. left breast) in the medical record for complete clinical information
Clinical Significance
Melanoma in situ of the breast skin and soft tissue represents early melanocytic malignancy confined to the epidermal layer of the breast skin, without invasion into the dermis. This must be distinguished from breast carcinoma in situ (ductal or lobular), which is an entirely different entity arising from breast glandular tissue. Cutaneous melanoma of the breast skin has the same prognostic implications as melanoma in situ at other truncal sites.
Documentation Requirements
- ✓Biopsy-confirmed melanoma in situ with pathology clearly specifying the breast skin as the site.
- ✓Laterality (right vs.
- ✓left) should be documented.
- ✓The distinction between cutaneous melanoma of the breast skin and breast carcinoma must be explicit in the pathology report.
- ✓Document margin status and surveillance plan.