D03.52 maps to CMS-HCC V28 23. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

ICD-10-CM Code View

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Code lookupD03.52

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Neoplasms (C00-D49) / In situ neoplasms (D00-D09)

D03.52

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

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.

Buddy Insight

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.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 23

Prostate, Breast, and Other C...

Coefficient HCC 23: 0.186 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 013

HHS-HCC 013 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 12

Breast/Prostate/and Other Can...

Code-level coefficient reference

RXHCC

Mapped

HCC 22

Prostate, Breast, Bladder, an...

Code-level coefficient reference

Code Book Path

Official

D03Melanoma in situ D03.5Melanoma in situ of trunk D03.52Melanoma in situ of breast (skin) (soft tissue)

Inclusion Terms

Official

No inclusion terms are included in this display for D03.52. Check the code and parent instructions in the Code Book.

Excludes 2

Official

No Excludes 2 notes are included in this display for D03.52. Check the code and parent instructions in the Code Book.

Related Codes

Official

D03.51Melanoma in situ of anal skin D03.59Melanoma in situ of other part of trunk

Includes

Official

Bowen's diseaseInherited from D00-D09
erythroplasiaInherited from D00-D09
grade III intraepithelial neoplasiaInherited from D00-D09
Queyrat's erythroplasiaInherited from D00-D09

Excludes 1

Official

No Excludes 1 notes are included in this display for D03.52. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for D03.52. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for D03.52. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for D03.52. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

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.

MEAT Support

HCC Buddy guidance

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.

Audit Caution

HCC Buddy guidance

The most critical pitfall is confusing cutaneous melanoma of the breast skin with breast carcinoma in situ, which are fundamentally different diseases.

Ensure the pathology confirms melanocytic origin with appropriate immunostains (S-100, Melan-A, HMB-45).

This code covers both skin and superficial soft tissue of the breast area.

Common Mistakes

HCC Buddy guidance

D05.10-D05.92 (carcinoma in situ of breast) are completely different entities arising from breast glandular tissue

D03.59 (melanoma in situ of other part of trunk) covers other trunk locations

C43.52 (invasive melanoma of breast skin) indicates dermal invasion

C50 series codes are for breast parenchymal malignancies.

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 D03.52 an HCC code?

Yes. D03.52 (Melanoma in situ of breast (skin) (soft tissue)) maps to HCC 23, Prostate, Breast, and Other Cancers and Tumors under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.186. 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: D03.52 is billable and maps to V28 HCC 23, Prostate, Breast, and Other Cancers and Tumors. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: D03.52
Description: Melanoma in situ of breast (skin) (soft tissue)
HCC (V28): HCC 23 — Prostate, Breast, and Other Cancers and Tumors
RAF reference coefficient: 0.186
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 23, Prostate, Breast, and Other Cancers and Tumors

0.186

ESRDHCC 12, Breast/Prostate/and Other Cancers and Tumors

Not separately weighted

RxHCCHCC 22, Prostate, Breast, Bladder, and Other Cancers and Tumors

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 D03.52 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for D03.52

For D03.52, 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

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 Prostate, Breast, and Other Cancers and Tumors (HCC 23) with a source-labeled community, non-dual, aged reference coefficient of 0.186. 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.

Specify whether the melanoma is on the breast skin itself versus other chest wall locations. For D03.52, 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 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.

Commonly Confused Codes

•D05.10-D05.92 (carcinoma in situ of breast) are completely different entities arising from breast glandular tissue
•D03.59 (melanoma in situ of other part of trunk) covers other trunk locations
•C43.52 (invasive melanoma of breast skin) indicates dermal invasion
•C50 series codes are for breast parenchymal malignancies.