D3A.095
BillableBenign carcinoid tumor of the midgut, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is D3A.095 an HCC code?
Yes. D3A.095 maps to Colorectal, Bladder, and Other Cancers under the CMS-HCC V28 risk adjustment model.
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 D3A.095
For D3A.095to 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 D3A.095 during that encounter — not just copy-forwarded from a problem list.
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 Colorectal, Bladder, and Other Cancers (HCC 22) with a community, non-dual, aged base RAF weight of 0.000. D3A.095 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. 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.
If the appendix is the confirmed site, consider if D3A.020 (appendix carcinoid) would be more specific. Because D3A.095 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 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.