D05.81 ICD-10-CM Code: Other specified type of carcinoma in situ of right breast
D05.81 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools
HCC Buddy Code Card
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FY 2026 Apr update / Neoplasms (C00-D49) / In situ neoplasms (D00-D09)
D05.81
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther specified type of carcinoma in situ of right breast
Other types of pre-cancerous breast cell abnormalities in the right breast that have not spread beyond the breast tissue.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for D05.81. Check the code and parent instructions in the Code Book.
Excludes 2
Official- malignant neoplasm of breast (C50.-)Inherited from D05
Related Codes
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- carcinoma in situ of skin of breast (D04.5)Inherited from D05
- melanoma in situ of breast (skin) (D03.5)Inherited from D05
- Paget's disease of breast or nipple (C50.-)Inherited from D05
Code First
OfficialNo Code First sequencing instructions are included in this display for D05.81. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for D05.81. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for D05.81. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
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 D05.81 an HCC code?
No. D05.81 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.
- Code
- D05.81
- Description
- Other specified type of carcinoma in situ of right breast
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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What This Code Means
D05.81 is the ICD-10-CM diagnosis code for other specified type of carcinoma in situ of right breast. Other types of pre-cancerous breast cell abnormalities in the right breast that have not spread beyond the breast tissue. D05.81 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering in situ neoplasms (d00-d09).
D05.81 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.
Use this code when documentation specifies a type of carcinoma in situ other than lobular or intraductal in the right breast.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for D05.81 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when documentation specifies a type of carcinoma in situ other than lobular or intraductal in the right breast
- •Ensure the provider has documented the specific type of carcinoma in situ to justify use of this code