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D3A.095 ICD-10-CM Code: Benign carcinoid tumor of the midgut, unspecified

D3A.095 maps to CMS-HCC V28 22. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

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Code lookupD3A.095

FY 2026 Apr update / Neoplasms (C00-D49) / Benign neuroendocrine tumors (D3A)

D3A.095

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

Benign carcinoid tumor of the midgut, unspecified

A benign hormone-producing tumor arising from the midgut (jejunum, ileum, or appendix) when the specific site cannot be determined.

Buddy the Bee presenting code insight

Buddy Insight

This code represents benign carcinoid tumors of the midgut (distal jejunum, ileum, appendix, and proximal colon) when the specific site is unspecified.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 22

Coefficient HCC 22: 0.363 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

N/A

—

Not mapped

ESRD/PACE

N/A

—

Not mapped

RXHCC

HCC 22

Code-level coefficient reference

Code Book Path

Official
D3A.0Benign carcinoid tumorsD3A.09Benign carcinoid tumors of other sitesD3A.095Benign carcinoid tumor of the midgut, unspecified

Inclusion Terms

Official

No inclusion terms are included in this display for D3A.095. Check the code and parent instructions in the Code Book.

Excludes 2

Official
  • benign pancreatic islet cell tumors (D13.7)Inherited from D3A

Related Codes

Official
D3A.090Benign carcinoid tumor of the bronchus and lungD3A.091Benign carcinoid tumor of the thymusD3A.092Benign carcinoid tumor of the stomachD3A.093Benign carcinoid tumor of the kidneyD3A.094Benign carcinoid tumor of the foregut, unspecified

Includes

Official

No Includes notes are included in this display for D3A.095. Check the code and parent instructions in the Code Book.

Excludes 1

Official

No Excludes 1 notes are included in this display for D3A.095. Check the code and parent instructions in the Code Book.

Code First

Official

No Code First sequencing instructions are included in this display for D3A.095. Check the code and parent instructions in the Code Book.

Use Additional

Official
  • code to identify any associated endocrine syndrome, such as:Inherited from D3A
  • carcinoid syndrome (E34.00)Inherited from D3A

Code Also

Official
  • any associated multiple endocrine neoplasia [MEN] syndromes (E31.2-)Inherited from D3A

Buddy Documentation Tip

HCC Buddy guidance
Use this code only when the exact midgut location cannot be determined from clinical documentation.
Query the provider for the specific anatomical site from surgical or pathology reports.
Document any symptoms of carcinoid syndrome (flushing, diarrhea, bronchospasm) and 5-HIAA levels if measured.

MEAT Support

HCC Buddy guidance
Use this code only when the exact midgut location cannot be determined from clinical documentation.
Query the provider for the specific anatomical site from surgical or pathology reports.
Document any symptoms of carcinoid syndrome (flushing, diarrhea, bronchospasm) and 5-HIAA levels if measured.

Audit Caution

HCC Buddy guidance
The appendix is a midgut structure, so if the appendix is identified as the tumor site, use D3A.020 instead of this unspecified code.
Do not use this code when the specific site is available in operative or pathology notes.
Midgut carcinoids may present with carcinoid syndrome, but this does not automatically make them malignant.

Common Mistakes

HCC Buddy guidance
D3A.020 (benign carcinoid of appendix) is used when the appendix is confirmed as the specific site.
D3A.021-D3A.025 cover specific colonic segments within the midgut territory.
D3A.094 (foregut) and D3A.096 (hindgut) cover different embryologic regions.

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 D3A.095 an HCC code?

Yes. D3A.095 (Benign carcinoid tumor of the midgut, unspecified) maps to HCC 22, Bladder, Colorectal, and Other Cancers under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.363. 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: D3A.095 is billable and maps to V28 HCC 22, Bladder, Colorectal, and Other Cancers. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
D3A.095
Description
Benign carcinoid tumor of the midgut, unspecified
HCC (V28)
HCC 22 — Bladder, Colorectal, and Other Cancers
RAF reference coefficient
0.363
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 22, Bladder, Colorectal, and Other Cancers
0.363
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 D3A.095 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for D3A.095

For D3A.095, 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

D3A.095 is the ICD-10-CM diagnosis code for benign carcinoid tumor of the midgut, unspecified. A benign hormone-producing tumor arising from the midgut (jejunum, ileum, or appendix) when the specific site cannot be determined. D3A.095 sits in the ICD-10-CM chapter for neoplasms (c00-d49), within the section covering benign neuroendocrine tumors (d3a).

Under the CMS-HCC V28 risk adjustment model, D3A.095 maps to Bladder, Colorectal, and Other Cancers (HCC 22) with a source-labeled community, non-dual, aged reference coefficient of 0.363. No V24 mapping is shown for D3A.095; use the applicable model and payment year when reviewing the V28 mapping. 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.

If the appendix is the confirmed site, consider if D3A.020 (appendix carcinoid) would be more specific. For D3A.095, 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 D3A.095 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •If the appendix is the confirmed site, consider if D3A.020 (appendix carcinoid) would be more specific
  • •Midgut carcinoids are the most common type and frequently present with carcinoid syndrome due to serotonin production

Clinical Significance

This code represents benign carcinoid tumors of the midgut (distal jejunum, ileum, appendix, and proximal colon) when the specific site is unspecified. Midgut carcinoids are the most common type of gastrointestinal carcinoid and are notable for their relatively high rate of serotonin production, which can cause carcinoid syndrome even in benign tumors.

Documentation Requirements

  • ✓Use this code only when the exact midgut location cannot be determined from clinical documentation.
  • ✓Query the provider for the specific anatomical site from surgical or pathology reports.
  • ✓Document any symptoms of carcinoid syndrome (flushing, diarrhea, bronchospasm) and 5-HIAA levels if measured.

Commonly Confused Codes

  • •D3A.020 (benign carcinoid of appendix) is used when the appendix is confirmed as the specific site.
  • •D3A.021-D3A.025 cover specific colonic segments within the midgut territory.
  • •D3A.094 (foregut) and D3A.096 (hindgut) cover different embryologic regions.

Child Codes

D3A.090Benign carcinoid tumor of the bronchus and lung
HCC 22
D3A.091Benign carcinoid tumor of the thymus
HCC 22
D3A.092Benign carcinoid tumor of the stomach
HCC 22
D3A.093Benign carcinoid tumor of the kidney
HCC 22
D3A.094Benign carcinoid tumor of the foregut, unspecified
HCC 22
D3A.095Benign carcinoid tumor of the midgut, unspecified
HCC 22
D3A.096Benign carcinoid tumor of the hindgut, unspecified
HCC 22
D3A.098Benign carcinoid tumors of other sites
HCC 22

Code Hierarchy

└D3ABenign neuroendocrine tumors└D3A.0Benign carcinoid tumors└D3A.09Benign carcinoid tumors of other sites└D3A.095Benign carcinoid tumor of the midgut, unspecified
└D3A.095Benign carcinoid tumor of the midgut, unspecified

D3A.095 code history

Code setChange
FY2017 (effective Oct 1, 2016)Description revised

Source: official CMS ICD-10-CM order and addenda files, FY2016 through FY2027.

Also searched as

  • D3A 095
  • D3A095

For D3A.095, 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.

D3A.095 maps to CMS-HCC V28 category 22, Bladder, Colorectal, and Other Cancers. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for D3A.095. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

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