D05.12
BillableIntraductal carcinoma in situ of left breast
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D05.12 an HCC code?
No. D05.12 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
D05.12 is the ICD-10-CM diagnosis code for intraductal carcinoma in situ of left breast. Abnormal cells found inside the milk ducts of the left breast that have not spread beyond the breast tissue; this is a pre-cancerous condition requiring monitoring and treatment. D05.12 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering in situ neoplasms (d00-d09).
D05.12 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Verify that documentation specifically identifies the left breast to avoid coding errors with laterality.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for D05.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify that documentation specifically identifies the left breast to avoid coding errors with laterality
- •Intraductal carcinoma in situ is also known as ductal carcinoma in situ (DCIS); both terms refer to the same condition